Is the inside of the wrist a safe site to start an IV

Specialties Infusion

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Hello fellow nurses, I am somewhat of a new RN, almost a year, and work at a SNF/LTC facility. Our patients are challenging for IV starts for a variety of reasons and finding a site is often difficult. I do always see veins in the inside of the wrist (distal anterior wrist) but I never start it there even if it is the only "good looking vein" simply because I never see patients with an IV started in that spot. I know it should be avoided since it is a place the patient will often bend, but are there other contraindications to starting and IV at this site? Is the inside of the wrist a safe site to start an IV ?

I found an article on the internet that the first 3 inches of the inside of the wrist should not be used because there is a risk of hitting a nerve and causing permanent nerve damage. Dose any one know if this is true?

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I don't have an intelligent answer, I don't know. Have never tried the area, sounds too painful!! Yikes!

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that is the rationale, as i remember

Hello fellow nurses, I am somewhat of a new RN, almost a year, and work at a SNF/LTC facility. Our patients are challenging for IV starts for a variety of reasons and finding a site is often difficult. I do always see veins in the inside of the wrist (distal anterior wrist) but I never start it there even if it is the only "good looking vein" simply because I never see patients with an IV started in that spot. I know it should be avoided since it is a place the patient will often bend, but are there other contraindications to starting and IV at this site? Is the inside of the wrist a safe site to start an IV ?

I found an article on the internet that the first 3 inches of the inside of the wrist should not be used because there is a risk of hitting a nerve and causing permanent nerve damage. Dose any one know if this is true?

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Specializes in Infusion Nursing, Home Health Infusion.

In 2011 the Infusion Nurses Society changed their recommendation about this area. It is 33IA and states " Avoid the lateral surface of the wrist for approx 4-5 inches b/c of the potential for nerve damage". They are referring to the area and vein jokingly called the" interns vein" b/c on autopsy they have found that the radial nerve crosses over the vein in 3 places so the potential to hit that nerve is fairly high. Nerve damage can cause chronic pain syndromes (regional pain syndromes and such) and many a patient has sued and won due to having to deal with chronic pain.

The volar wrist is also a very vulnerable area and it it also painful so yes it should be avoided as well. it is also an area of flexion which will increase the rate and severity of phlebitis and leaking at the site.

If you ever do hit a nerve with the point of your needle...immediately pull it out. The patient will report feeling an electric shock sensation. That usually solves the problem but with IV sites if the nerve sustains prolonged pressure or irritation the pain can become chronic. We have to be extremely careful when placing PICCs especially though the brachial vein as there is a rather large nerve and nerve bundle there. We have even had to remove a PICC on a few occasions b/c we determined the PICC was irritating the nerve there.

It is tempting to use the wrist sites..but STOP yourself as many of the lawsuits related to IV therapy have been caused by IV statts in that location. better to spend the extra time looking for a better location.

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So, this precludes using the "snuff pocket" too. oh well, good to know.

In 2011 the Infusion Nurses Society changed their recommendation about this area. It is 33IA and states " Avoid the lateral surface of the wrist for approx 4-5 inches b/c of the potential for nerve damage". They are referring to the area and vein jokingly called the" interns vein" b/c on autopsy they have found that the radial nerve crosses over the vein in 3 places so the potential to hit that nerve is fairly high. Nerve damage can cause chronic pain syndromes (regional pain syndromes and such) and many a patient has sued and won due to having to deal with chronic pain.

The volar wrist is also a very vulnerable area and it it also painful so yes it should be avoided as well. it is also an area of flexion which will increase the rate and severity of phlebitis and leaking at the site.

If you ever do hit a nerve with the point of your needle...immediately pull it out. The patient will report feeling an electric shock sensation. That usually solves the problem but with IV sites if the nerve sustains prolonged pressure or irritation the pain can become chronic. We have to be extremely careful when placing PICCs especially though the brachial vein as there is a rather large nerve and nerve bundle there. We have even had to remove a PICC on a few occasions b/c we determined the PICC was irritating the nerve there.

It is tempting to use the wrist sites..but STOP yourself as many of the lawsuits related to IV therapy have been caused by IV statts in that location. better to spend the extra time looking for a better location.

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Specializes in HH, Peds, Rehab, Clinical.

LOL, whether its recommended or not, no way in HE.. would I let anyone start an IV for me there, ergo, I would never do that to a patient!

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Painful and they infiltrate easily. Only if they're unconscious, have no access and need D50 right now and nothing else to be found. In other words, emergency use only. If you're down to using those veins, you probably need a different type of access

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NEVER I repeat NEVER do this! If a doctor wants to let them do it under their license! As I am currently suing an anesthesiologist for permanent nerve damage in my right hand for putting in a positional line before surgery! I asked repeatedly for a PICC LINE but oh no they insisted on spending 3.5 hours sticking me over EIGHTY times until finally getting a terrible stick in my wrist! It was for a severely impacted kidney stone w/ obstruction that had been there for ~ 2 years! Dr screwed up first surgery only looked at my bladder & told me nothing was wrong. They couldn't finish the first surgery surgeon knicked my kidney & thought it might rupture, second surgery had to stop due to infection third was successful but now I'm permanently disabled from a damn kidney stone & an inappropriately placed IV! Never place an inner wrist unless you have great insurance, hate your job & want to harm humans! I really don't enjoy the fact I can't even pick up a cellphone anymore thanks to an IV & I was the one who got called for "impossible sticks" yet even I knew better than that! Just AVOID AVOID AVOID

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Wow! I can't believe you went through all that! @Vix1pal. So sorry that happened to you. I never ever went after wrist veins. Nurses at my last job did it all the time!

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Specializes in Infusion Nursing, Home Health Infusion.
NEVER I repeat NEVER do this! If a doctor wants to let them do it under their license! As I am currently suing an anesthesiologist for permanent nerve damage in my right hand for putting in a positional line before surgery! I asked repeatedly for a PICC LINE but oh no they insisted on spending 3.5 hours sticking me over EIGHTY times until finally getting a terrible stick in my wrist! It was for a severely impacted kidney stone w/ obstruction that had been there for ~ 2 years! Dr screwed up first surgery only looked at my bladder & told me nothing was wrong. They couldn't finish the first surgery surgeon knicked my kidney & thought it might rupture, second surgery had to stop due to infection third was successful but now I'm permanently disabled from a damn kidney stone & an inappropriately placed IV! Never place an inner wrist unless you have great insurance, hate your job & want to harm humans! I really don't enjoy the fact I can't even pick up a cellphone anymore thanks to an IV & I was the one who got called for "impossible sticks" yet even I knew better than that! Just AVOID AVOID AVOID

I am so sorry this has happened to you.I think hospitals should always have IV teams for the difficult patients that others can not get.They should have never attempted that many times and should have had someone on staff to start a an US guided PIV if they did not want to place a PICC.I think some nurses do not realize how much damage can be done with an IV needle.As a wise nurse once told me...an IV cannula is a weapon and if you are going to use it to help someone you better know what you are doing.

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A nurse, angry because I reported her for neglect, flushed my IV with three 5cc syringes, as fast as she could possibly pump them in, blowing out the IV. Then she placed the new IV on the inside of my wrist, on my dominant hand. It immediately caused excruciating pain, after about 15 minutes, I demanded it be removed, and told them I didn't want her anywhere near me. The hospital lied, said a nursing supervisor was present when this took place, and in her opinion, it was the best option. I have muscular arms, with plenty of good veins, and numerous good veins on the back of my hands. A week later, I'm still having significant pain, limited use, and weakness in my thumb. Was this right? Should I file a complaint with the state? TIA

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J D The Bee Guy said:

A nurse, angry because I reported her for neglect, for abandoning me in the bathroom, the day after spinal fusion surgery, flushed my IV with three 5cc syringes, as fast as she could possibly pump them in, blowing out the IV. Then she placed the new IV on the inside of my wrist, on my dominant hand. It immediately caused excruciating pain, after about 15 minutes, I demanded it be removed, and told them I didn't want her anywhere near me. The hospital lied, said a nursing supervisor was present when this took place, and in her opinion, it was the best option. I have muscular arms, with plenty of good veins, and numerous good veins on the back of my hands. A week later, I'm still having significant pain, limited use, and weakness in my thumb. Was this right? Should I file a complaint with the state? TIA

 

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