Website for acceptable IV insertion sites?

hellerd2003, RN · Apr 4, 2007

I guess I'm confused. Are you looking for an anatomical chart? Because there really is no "wrong" place to put a PIV as long as it's in a vein and patent. Arterial PIV's are a huge no-no, of course (once saw a tragic case where a pt lost an arm because people were putting meds into a line that had been inadvertently placed in an artery-- don't know HOW several shifts missed that one!).

Realize, too, that anatomical charts are just the "norm", not the rule. I cannot feel my own carotid pulse on my right side. I never thought anything of it until, for other reasons, I had a carotid ultrasound done. Turns out my R carotid is placed oddly, and thus cannot be palpated!

The best advice I got re. finding PIV sites was to simply practice feeling them on yourself, coworkers, etc. The wrist/ forearm below the thumb is a good spot. Usually there is also something on the ulnar forearm. A/C's are great for immediate access, but if a patient is a long-term person, they tend to go bad and if you're giving drugs that can cause tissue damage, it make take longer to recognize the damage. The patients we get from the ED always have A/C's, and we usually start another line in a different spot just because, while they're a nice large bore needle for the most part, they tend to go bad over more than a day or so. Hands are good for visual veins, but often will infiltrate, in my experience. I don't like starting IV's with only a visual approach, because sometimes something that looks good will be anything but. I also tend to avoid any body part that has a lot of movement, if I can, because the IV's can kink or get dislodged. But beggars can't be choosers, can they? ;-) Babies can get foot and scalp IV's. But, because of my setting (ICU), I tend to use forearms due to lack of movement and their 'staying power'. You can't see them for the most part, so you practice feeling. Veins feel a bit spongy. Tendons are harder. Just keep practicing! It'll come with time and you'll find your "guarantee" spots.

Hope that helps!

Larry77, RN · Apr 4, 2007

Any good vein is great for an IV but you have to think about patient comfort if it's going to be in for a few days. I work in the ED and am one to try and find a vein other than the AC (unless a code/trauma situation) first. There are a lot of ED nurses that look for an AC first, my feeling is that this is bad practice because this is one of the most uncomfortable places to have an IV for the patient (in my own experience) and there are many, many other places for great IV's that don't have the positional problems that AC's have.

I did do a quick search on google and found some literary advice for placements in the arms etc but no charts. I think it will screw you up if you are thinking too much about where the IV should be rather than just looking for a great vein that's not going to be a "bad" location.

javanurse2000, BSN, RN · Apr 4, 2007

I'm sorry, I know the OP was written vaguely, I was just trying to follow the rules and not ask advice, rather ask for resources where I could find the info. I haven't worked with IVs in years, so I just didn't remember where the most optimal sites are and where there (if there) are no-no's. After a recent ER trip, a friend showed me her wrist (NOT the area proximal to the thumb...this was more directly in the interior of the forearm but very close to the wrist, before the vein branches). They ran almost a L with the meds...I was suprised, because I thought that was an unusual location for an IV. A vein so small and proximal to the skin. Yes, she's pretty sore. no infiltrate...just bruised, a bit swollen and sore.

Thanks for responding!

queenjean · Apr 4, 2007

As floor nurses in my hospital, we put them anywhere on the arm where we can find a vein. If I have my choice of veins, I will usually choose the dorsal forearm--not as irritated with movement, just seems like you get lots of straight shots, don't seem to roll like the hand veins sometimes do, fewer intersections and valves. I've put them in the finger veins before, when that was literally the only vein I could find. The only place I won't go is the volar wrist--I'm too scared of doing nerve damage. That's probably just my issue, but there you have it. Our IV therapy team will put them there as a last resort.

cardsRN · Apr 4, 2007

if i were you i'd check your facility policy for the "no-no" spots. at my facility they are inner wrist (potential arterial access, nerve damage) and lower extremities (foot IV + diabetic= bad idea) ask your IV team if you have one

or try here www.ins1.org the infusion nurses society website.

fgoff · Apr 4, 2007

Try http://www.nursingcenter.com/prodev/ce_article.asp?tid=582125

javanurse2000, BSN, RN · Apr 4, 2007

Try http://www.nursingcenter.com/prodev/ce_article.asp?tid=582125

Wow! this was a great site....VERY informative. Unfortunately, this nurse chose to use the arm where my friend had her recent shoulder surgery, infiltrated on the first attempt (A/C) and then used the inner wrist distal to the infiltrate. Everything I'm seeing on this website and another I checked out cautions against choosing the inner wrist b/c of the risk of nerve damage. This really is a great website---thank you for posting it and thanks also to everyone else who's shared their experience! -Wendy

fgoff · Apr 4, 2007

I use it quite a bit! I think it originally came from this site. Glad it helped you too.

fgoff

Roy Fokker, BSN, RN · Apr 5, 2007

I put 'em where I find 'em

My sites of choice are the dorsal and ventral forearms (the poor basilic vein is often overlooked/ignored)

Dorsal wrists thumbs next.

Ante-cubes are next in line (unless it's ED/ER - there is a reason they start AC first)

After that, it's literally a free for all :uhoh21:

**canoehead, BSN, RN** · Apr 6, 2007

I'm in the ED, and the only nurse on nights. If it's blue and I can hit it, that's where it goes.

Fingers, knuckles, and feet are my most commented on sites, but I'll change them out once a patient gets better and there is more to stick. People seem to crab more about having a 24 needle than about where it is, but if someone is a hard stick I would rather have a tiny IV than none at all.