IV Placement - distal or proximal??


  • Specializes in Emergency. Has 1 years experience.

Hi all,

I'm a new grad and I just started my first job - ER in big city hospital. Yesterday was my first day and my preceptor told me I would place an IV. I've done this a lot in my final practicum with a couple of seasoned nurses in another ER in the same city. Those nurses and every single nursing instructor, have said that you must start the IV distally and then move proximally, because if you blow the vein proximally it might infiltrate if you start in the same vein more distally. You also want to preserve the bigger veins in case of an emergency. This makes sense and that's what I've been doing.

Coming back to me starting this IV, my preceptor told me you always start proximally and move distally because afterwards you can't draw bloods off that arm if you, lets say, place the IV in one of the veins in the hand. I don't understand this rationale at all. Why not just draw off the other arm then? Can someone please explain this to me?



63 Posts

Specializes in OB, MS, Education, Hospice.

Hi there--

Your preceptor is mistaken...and you are correct. You start IV's distally and move proximally with subsequent starts...

locolorenzo22, BSN, RN

1 Article; 2,396 Posts

Specializes in Ortho, Neuro, Detox, Tele.

I've been told to move proximally...after all, after you stick in the arm, you don't want to stick in the hand in the same vein and not have your meds or fluids go into the right vein. You can draw blood above the IV though....I've seen it done.


977 Posts

Specializes in Med Surg, ER, OR.

yep you are right. it may be easier to start proximally, but it does present more problems. I look at the hand first, but love wrist/forearms and lastly AC, but if needed now, hit it first!

Megsd, BSN, RN

723 Posts

Specializes in Neuro.

The issue with lab draws only exists if the person has fluids running because of the risk of diluting the sample. So our lab people either draw in the other arm, or ask if we can pause the fluids for 5-10 minutes before they draw.

I always start distally too, and we only use the AC as an emergency access if for no other reason than when they bend their elbow, the IV pump alarms and drives the patient and staff crazy!


6,011 Posts

Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89. Has 30 years experience.

Always distal. And try to avoid joints . Us the smallest catheter that will accomplish the goal and always flush first and last if you don't have fluids running. Try to avoid labs on that side if at all possible. A small cath with a tourniquet for labs above it will probably clot off your site.


1 Post

No! You are incorrect. According to Infusion Nursing Standards, the selection of an IV site should be proximal to any previous canuulation sites; its proximal to distal... I would prefer to refer students to the national standards.

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