Antecubital vein for chemo

[sporush]

Hi everyone-

I'm new here on AllNurses and have a question. I work in an outpatient infusion center and the majority of our patients have ports. We do, however have some patients for whom we place PIVs for chemotherapy. Our manager (not an oncology RN) just sent us an article advising NOT to use antecubital IVs for chemotherapy due to the extra space and fear of infiltration/extravasation, and wants us to stop using them. Has anyone heard this? We usually use the AC vein because it IS a larger vein and therefore less prone to infiltration while infusing. We hesitate to change our practice altogether here simply because of one article. We have been searching online but cannot find any evidence based articles discussing this topic.

Thank you so much!

[brownbook]

There was a really good discussion about this. It is in the Specialities section under Infusion Nursing. About half way down the page of posts, the title is Is This True, by SallyRN. It was posted Nov. 2015 but it is very pertinent. Read through all the replies. Many good articles in journals are referenced. Many good replies by other nurses.

It comes down to.....yeah it is kind of sort of true, but ???? IV's are still placed in almost every site the article mentions as being problematic 1000's of times a day all over the country. Mainly be careful with any IV insertion, assess the site, any complaints of pain by the patient (outside of ouch it hurts when you pierce the skin) take seriously. But don't take my word for it. Read the post and comments.

Unfortunately the answer to your question is kind of, "it is clear as mud." Perhaps you could get a doctor's input or maybe unofficial, or official, okay to use these less than ideal sites for infusion?

[Swellz]

I thought the concern was damage to the elbow joint? I can't recall ever giving chemo via an AC PIV but we had a lot of nurses who were good with IVs when I worked onc.

[Double-Helix, BSN, RN]

What it really comes down to is depth of the vein and length of the catheter. Ideally you want at least 2/3 of the length of the catheter inside the vessel to avoid dislodgment from shifting of the tissues and skin above the vein. In an antecubital vein there is greater potential for movement of the catheter within the vessel related to bending of the elbow. For that reason, I always choose a longer catheter for an AC vein and don't prefer them for long term use whenever possible. If it is an IV that needs to stay in for several days, some kind of arm immobilizer should be in place to help prevent this kind of movement. For a short term infusion on an adult patient that can be trusted to refrain from bending the arm, I wouldn't worry about it- provided that it's not a super deep vein and a short catheter.

[MunoRN, RN]

There are two contradictory views on infusing chemo using a peripheral IV that could be used to argue both for and against using the AC.

The first is that areas of flexion should be avoided as peripheral IV sites, which would exclude the AC. The other is that given the risks of chemo infusing into a peripheral IV, frequent site checks should occur and that a free flowing blood return should be part of the assessment, which then necessitates a large bore IV in a large vein, ie the AC area, to ensure you'll be able to draw back blood throughout the infusion, since other sites are less likely to have blood return anytime after the initial IV start.

I've seen oncology floors and radiology policies that only allow chemo or contrast through an AC site, I don't know that I've seen either that prohibit it.

[Double-Helix, BSN, RN]

I suppose the other concern is that if you have a severe extravasation in the AC, you've compromised all IV sites distal to that AC. If a hand vein extravasates, you can still use veins above that site.

Absolutely, frequent site assessments and brisk blood return are a must.

[mjt0080]

You do not use AC for chemo administration unless it is your last option and there is not other vein access. It is not recommended to administer chemo there there is a bend in the joint. and extra tissue of the upper arm can make it difficult to detect infiltration and can lead to greater damage. This is standard practice everywhere I have ever worked as an oncology infusion nurse.

[decembergrad2011, BSN, RN]

If they need it for chemo when I go to start a peripheral IV, I attempt to stick it in the forearm, avoiding wrist and AC. I'm not real keen on giving chemo through a peripheral IV because *many, many* times I've not been able to get blood return after the initial placement, and other times I've been able to get it at the start of chemo but not at the end.

[DatMurse]

You do not use AC for chemo administration unless it is your last option and there is not other vein access. It is not recommended to administer chemo there there is a bend in the joint. and extra tissue of the upper arm can make it difficult to detect infiltration and can lead to greater damage. This is standard practice everywhere I have ever worked as an oncology infusion nurse.

this!