Placing IVs in shoulder, breast, upper chest

[paphgrl]

When I have encontered patients with difficult IV access I have placed IVs in shoulders and sometimes in veins of the breast. I have had good success with these sites. I have not seen other nurses do this. Has anyone ever utilized there peripheral veins? Are there any contraindications that prevent RNs from utilizing these sites?

Your input is valued,

PG

[apocatastasis]

I don't like breast/chest areas because of the extravasation risk; that area's prone to a lot of movement and it's difficult to protect the site. Shoulder is iffy, but can work fine if they have a large enough vein.

I typically avoid anything more than halfway up the upper arm. I work in the ER, and if they lack peripheral veins, it's time for an EJ, a central line, or a call to the PICC RN to put in peripheral line (or PICC) using ultrasound.

[VivaLasViejas, ASN, RN]

I've done a couple in the thumb, and several in the foot. Anything more complicated than that and it's time for a PICC or central line, IMHO.

[Ahhphoey]

The most I've personally tried is upper arm not far from the shoulder, but that was in the ICU in a patient that was in dire need of access and IR was not open at the time (small hospital, evening shift). I've only done a foot in a code situation as we did not have an IO gun available in our ICU. I have never attempted a breast nor would I personally. I honestly am not certain of the increased risks (if any) exist in that area, but then again, that's just why I wouldn't do it

[dreamingofbeing]

I've seen IV's just about everywhere from pts sent down to IR for PICC placement. I don't like the ones in the breasts it just doesn't seem like an ideal place and appears really uncomfortable.

[SHGR, MSN, RN, CNS]

I always wondered about this. I have really surface veins, the kind that look like a road map LOL, so if I wear something like a swim suit or a strapless top it's like WHOA VEINS. I'd let someone start an IV in my chest, but that's just me I guess.

[imintrouble, BSN, RN]

We frequently place IVs in the upper arms as a last resort. I took care of a pt with one in their neck:eek: and it wasn't a central line.

We get pretty creative where I work. I have never put one in the chest, but shoulder down is fair game as far as I'm concerned.

[jbluehorseh]

I have started them in the chest/ shoulder before with a 24 or 22, but i do agree with other poster that they are only for short trem use. It is better to have a US IV or if the patient can wait for PICC.

[6spdftwtm]

Theoretically, the BEST site for a PIV is in the forearm. Hand is contraindicated due to extravasation and very little soft tissue there. Wrist contraindicated due to high risk for compartment syndrome if infiltration. AC is actually contraindicated due to close proximity to brachial artery and high concentration of nerves.

The BEST place for an IV is forearm and that's where I always stick if I have the option. And in a situation that is not emergent, smallest IV size that can actually accomplish the job you need.

Now, with that said, being in ER, I have seen and myself started several lines in the upper arm (which doesn't make me as nervous) and shoulder and chest. ER nurses get pretty non-traditional in emergent or critical situations. But then again, infiltration is usually discovered and corrected within minutes as the staffing ratio is better in ER than on floor.

Late,

Trav

[weezledawg]

I agree, the forearm is the best.

[weezledawg]

I just agreed with Trav, that the forearm is the best ... that being said, I have put IVs in feet, hands, thumbs, necks, fingers, neonates, breasts, chests, shoulders, forearms, wrists, under the upper arm, over the upper arm, bracheocephalic veins, cephalic veins, basilic veins, you name it, I have hit it. If I see a river and you need an IV, it is fair game. No, the chest is not ideal. But neither is an angry surgeon who does not want to place a triple lumen and IV medications that are necessary. Yes, they are harder to secure. But I have seen the best of the best forearm IV sites get infiltrated and ripped out, and the most precarious chest IV or shoulder IV make it three days because the nurse and patient were meticulous.

[SHGR, MSN, RN, CNS]

Trav-

We don't start a ton of IV's and so I'm not the best at it. Your rationale makes a ton of sense though. Thanks.

[veinwhisper]

I agree with weezledog. I have been RN 40 years in Level 1 trauma 450 bed facility in midtown. I have worked in all the ICUs and ED. I work nights, NO PICC team on nights. I am called for difficult IV sticks. I don't put them in the breast for vancomycin, Dilantin, Phenergan or pressors. We don't use central or PICC lines for patients with positive blood cultures if at all possible for 48 hours. I have never had a problem with chest,breast lines and patients state they are less painful. I have used belly veins in the liver patients (make sure you put them in going the right direction). there is a little shoulder vein that I have seen last for days with a 22g. Forearm is obviously my favorite. You can do miracles with a good tourniquet (over their gown), HEAT, 22g and a veinlite ($250.00) Our team uses these all the time with excellent results. I have put lines in patients that PICC could not get and ED physicians could not get with ultrasound. BUT when we need an emergent IV, we choose this over IO. Additional chance of infiltration is less than you would think. I have many patients ask for me when they are admitted.