Iv site on the brachial superficial vein

IVRUS, BSN, RN · Feb 15, 2005

BFX,

Are you referring to the brachial vein in the upper arm, as this usually is positioned too deep to access by normal means, or are you referring to the median antebrachial vein in the forearm?

I assume since you are saying that it is closer to the heart, that you mean the vein in the upper arm. In most cases, (in the absence of Ultrasound) you are only able to cannulate the basilic vein or the cephalic vein in the upper arm. The basilic vein is the larger of these two vessels.

Phlebitis can be seen in many forms:

1. Chemical phlebitis can be due to harsh medications (those with a pH of 9, a osmolarity of > 500, an amino-acid of > 5% or a dextrose concentration of > 10%) or it may be due to powder on ones gloves.

2. Bacterial phlebitis can occur with inappropriate or lack of cleansing the site before insertion, or from contaminated equipment or suppiles.

3. Mechanical phlebitis can occur from positioning an IV too close to an area of flection, or even from improper taping which could allow for the in and out, or pistoning movement of the IV catheter in the vein.

So, you see phlebitis can be caused by many things, however, having the IV catheter closer to the heart is not one of them. IV catheters located in the SVC have a decreased chance of developing chemical phlebitis as you have a blood flow of > 2 liters a minute thus quickly diluting the medication.

You do have an increased risk of developing thrombus if the catheter terminates in the midclavicular area (subclavain) and therefore, INS (Infusion Nurses Society) discourages this type of placement.

As far as placing lines in the foot... Don't do it!

The elderly are especailly predisposed to venous stasis so thrombosis is a real concern with lower extremity cannulation.