Which vein do you prefer

FlyingScot, RN · Aug 12, 2010

The one most convenient for the patient. Non-dominant side, not over a joint and one I can reasonably assume I will get in on the first stick.

Asystole RN · Aug 12, 2010

If you are asking which veins to look for I would suggest the radial vein, basilic, cephalic, ulnar.

On a personal note: This week I have really been into sticking shoulders for some reason. Out of the patient's way, doesn't inhibit movement, confused patients leave it alone, nice large virgin veins...many people forgot to look above the AC.

IVRUS, BSN, RN · Aug 14, 2010

If you are asking which veins to look for I would suggest the radial vein, basilic, cephalic, ulnar.
On a personal note: This week I have really been into sticking shoulders for some reason. Out of the patient's way, doesn't inhibit movement, confused patients leave it alone, nice large virgin veins...many people forgot to look above the AC.

The radial and ulnar vein are deep vessels, and not ones that are easily assessed without U.S. I'd also be concerned sticking a vessel in the shoulder area... First there usually aren't vessels found in this area as they are buried deep here. So the fact that you are sticking them, (though you aren't stating whether you are using US or not) is a concern. because you must question WHY IS IT THERE???

But to answer the question: Start distally, if possible to save the proximal veins for future VP. There are many factors to consider when choosing a vein, however, not just its location. One factor is how long of therapy are you looking at? You wouldn't want to have the pt being stuck q 72 hours for 14 day, much less 6 weeks of IVAB

Rx. Also, is this an emergency setting and you're looking for advice... Most of those professionals in ER go for the ACF veins as they are easy to palpate and access. Another important point is what are you infusing? Digital veins only for isotonic solutions without additives. Avoid metacarpal veins of those with obvious arthritic hands and avoid metacarpal veins for those who have those ropes, on the back of their hands, or for those who use walkers, or are compulsive hand washers. Do not place short term peripherals on the underside of the patient's forearm as the nerves of the brachial plexis are plentiful here and infiltrations/extravasations can be determental here. Any solution with an osmolarity > 600, a pH 9, a dextrose concentration>10% or an amino acid > 5% should go centrally.

iluvivt, BSN, RN · Aug 14, 2010

Again IVRUS is right on and a highly educated well read intravenous nurse..we rarely disagree. Please avoid the wrist including the volar wrist as about 60 percent of lawsuits related to peripheral IV Therapy are in this location...if you see a vein there trace it up with your fingers and catch it above the wrist. You may not see it as well but you can train yourself to feel it and then be able to access it. Always palpate the vein first so you can determine its condition and review the factors IVRUS stated

1 Many choose to use the dorsal metacarpal veins first to preserve the more proximal ones for future therapy

2 Work your way up the arm to the FA cephalic and accessory cephalic..the median antebrachial veins of the FA can also be used

3 YES avoid the ACF for routine IV therapy..when these large veins are damaged it often results in phlebothrombosis...this also limits these veins for PICC placement. OK in an emergency if you can not get anything else..USE it and re-site ASAP..but that is often not done and they are left in to infiltrate and extravasate and the vein is damaged and non-compressable ..basically a mess. These are blood drawing veins and should be preserved for that function

zahryia, LPN · Aug 14, 2010

Again IVRUS is right on and a highly educated well read intravenous nurse..we rarely disagree. Please avoid the wrist including the volar wrist as about 60 percent of lawsuits related to peripheral IV Therapy are in this location...if you see a vein there trace it up with your fingers and catch it above the wrist. You may not see it as well but you can train yourself to feel it and then be able to access it. Always palpate the vein first so you can determine its condition and review the factors IVRUS stated
1 Many choose to use the dorsal metacarpal veins first to preserve the more proximal ones for future therapy
2 Work your way up the arm to the FA cephalic and accessory cephalic..the median antebrachial veins of the FA can also be used
3 YES avoid the ACF for routine IV therapy..when these large veins are damaged it often results in phlebothrombosis...this also limits these veins for PICC placement. OK in an emergency if you can not get anything else..USE it and re-site ASAP..but that is often not done and they are left in to infiltrate and extravasate and the vein is damaged and non-compressable ..basically a mess. These are blood drawing veins and should be preserved for that function

Huh! Thanks for pointing this out.

zahryia, LPN · Aug 14, 2010

The radial and ulnar vein are deep vessels, and not ones that are easily assessed without U.S. I'd also be concerned sticking a vessel in the shoulder area... First there usually aren't vessels found in this area as they are buried deep here. So the fact that you are sticking them, (though you aren't stating whether you are using US or not) is a concern. because you must question WHY IS IT THERE???
But to answer the question: Start distally, if possible to save the proximal veins for future VP. There are many factors to consider when choosing a vein, however, not just its location. One factor is how long of therapy are you looking at? You wouldn't want to have the pt being stuck q 72 hours for 14 day, much less 6 weeks of IVAB
Rx. Also, is this an emergency setting and you're looking for advice... Most of those professionals in ER go for the ACF veins as they are easy to palpate and access. Another important point is what are you infusing? Digital veins only for isotonic solutions without additives. Avoid metacarpal veins of those with obvious arthritic hands and avoid metacarpal veins for those who have those ropes, on the back of their hands, or for those who use walkers, or are compulsive hand washers. Do not place short term peripherals on the underside of the patient's forearm as the nerves of the brachial plexis are plentiful here and infiltrations/extravasations can be determental here. Any solution with an osmolarity > 600, a pH 9, a dextrose concentration>10% or an amino acid > 5% should go centrally.

Thank you. This was very helpful.

Rexie68 · Aug 15, 2010

The lower cephalic and median veins are my favorites for peripheral IVs!