Fastest route to the heart via IV access?

Specialties Emergency

Published

So today I got into a mini debate with another nurse about which route is the fastest to the heart for peripherally IVs. The debate started when we were giving Adenosine for SVT 250HR. (Delay in care did not occur, it was discussed after the fact)

At one time, whether it was in school or precepting in the ED I learned that the fastest route to the heart is using the right arm and going for AC or upper arm if possible, despite the fact the heart is on the left side. While I'm sure if there is an actual difference, it's miniscule for things like CTA's and administering Adenosine. Just for the fun of knowing, can anyone tell me which arm is a faster route to the heart for IVs and any proof if you're able to provide it.

I would say a right EJ would probably be the fastest, since the right innominate is shorter than the left.

Specializes in Emergency Department.

Shortest peripheral? Right EJ... In any event, you're going to want to slam the Adenosine in and immediately slam a good flush in right after it to ensure that it gets into the central circulation and into the heart. If there were an IV in each AC, of equal gauge, I'd likely choose the right side as there's a "straighter" path from the arm to subclavian to SVC on that side vs the left side. The "approach" from the left requires a pretty significant turn to enter the SVC from the left subclavian. In practice, go with whatever side you're closest to when you're handed the Adenosine and flush. Since you're dealing with a beating heart and at least some blood flow, it really won't matter much.

Incidentally, if all I had was a tibial IO, I'd still slam in the Adenosine, but I'd choose a larger volume for the flush.

Specializes in Family Nurse Practitioner.

If i had a line in the left arm that worked better/better blood return than the rignt arm i would use that line. A good line is key. We had this once. They kept slamming the adenosine to the 20 in the ac which had no blood return but had just been started. I started a line in the other arm in the upper forearm which pulled great and that is the line we used to give the dose which broke his SVT.

Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

The difference between right and left arm would be milliseconds if their is any. PIV for Adensoine should be placed in the AC if possible instead of more distal.

Annie

For those saying EJ, I was speaking for IVs that RNs (at least in my hospital) are allowed to obtain. I would agree an EJ would be fastest, but I was speaking more in terms for which arm. We had bilateral 18's (I put one in the left as someone put one in the right). The right was upper arm (patient was muscular so it was fairly easy access) and I got an AC on the left side. The primary nurse wanted one on the left, though I suggested the right is fastest as that's what I learned somewhere at some point in time.

Thanks everyone for their input =)

We broke SVT with 1 dose so in the end that's all that matters.

RNs are allowed to insert EJs at my hospital, but it's generally an act of desperation.

Again, in theory, the right would be quicker than the left due to the shorter distance to the right atrium, but as someone else stated, it would probably only be milliseconds.

Specializes in Emergency Department.
For those saying EJ, I was speaking for IVs that RNs (at least in my hospital) are allowed to obtain. I would agree an EJ would be fastest, but I was speaking more in terms for which arm. We had bilateral 18's (I put one in the left as someone put one in the right). The right was upper arm (patient was muscular so it was fairly easy access) and I got an AC on the left side. The primary nurse wanted one on the left, though I suggested the right is fastest as that's what I learned somewhere at some point in time.

Thanks everyone for their input =)

We broke SVT with 1 dose so in the end that's all that matters.

If you have 18's in each AC and both aspirate/flush equally well, just pick one, slam the adenosine in followed by a solid flush. There is going to be effectively no physiologic difference. The key thing is going to be the flush as that will move the adenosine bolus along quickly.

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