Why do you choose to start IVs in certain veins

[DorothyR]

I tried to start on IV today and I was preparing to stick the hand veins. However, my nurse told me to start on the forearm.

What do you consider when choosing a vein for IV? Type of solution/continuous vs. intermittent infusion/other factors? Why not start IVs on the hand if the veins are visible/palpable instead of going to forearm or other areas?

[psu_213, BSN, RN]

This must be facility-specific because I've never heard of such a thing... and that sounds IMPOSSIBLE in pediatrics.

My comment is for adults--the common mantra for CTAs (for instance, R/O PE) is "20 above the wrist," however a CT tech once specified that it had to be in the AC. Not really sure why it had to be AC though...

I was also taught by an ex-medic RN that adenosine must (should?) be given in the AC or higher (because, of course, of how fast it is metabolized in the blood stream). Not sure if this is 100% true, but the times I have see adenosine work, it has been AC IVs (although it may not have worked in some of those cases R/T the type of SVT).

[ChristineN, BSN, RN]

This must be facility-specific because I've never heard of such a thing... and that sounds IMPOSSIBLE in pediatrics.

Yeah that advice I posted only applies to adult pts, which is primarily the group you would be doing a cardiac CT on more commonly. I have also worked peds, and understand that in kiddos you take whatever access you can get, regardless of location or catheter gauge.

[Aurora77]

I work post-OP/ortho. I always, if possible, try to go for the non dominant forearm. Hands are good, but those IVs don't last long when patients are using walkers to ambulate multiple times per day. The size depends on the patient's needs. If they are only getting occasional antibiotics or pain meds, I'll use a 22. If there's a good chance they'll need blood, I put in a 20. I only use 18s if they're going to CT and they go in the AC per policy. I agree with your nurse. I only use the hands if that's the only vein I'm confident I can hit on the first try. Otherwise, start with the lower forearm and you still have room to move up, if you need to.

[SaoirseRN]

I work post-OP/ortho. I always if possible, try to go for the non dominant forearm. Hands are good, but those IVs don't last long when patients are using walkers to ambulate multiple times per day. The size depends on the patient's needs. If they are only getting occasional antibiotics or pain meds, I'll use a 22. If there's a good chance they'll need blood, I put in a 20. I only use 18s if they're going to CT and they go in the AC per policy. I agree with your nurse. I only use the hands if that's the only vein I'm confident I can hit on the first try. Otherwise, start with the lower forearm and you still have room to move up, if you need to.[/quote']

This almost exactly, except we do run blood through a 22.