Multiple factors determine the route and site for vascular access, and knowing the basic anatomy, techniques, indications, and contraindications is essential to emergency care.
Infusion rate is key in the resuscitation of those with severe hypovolemia or hemorrhage.1 Infusion rates through a medical catheter behave according to Poiseuille’s law:
The rate of flow is directly proportional to the catheter radius and the pressure gradient, and inversely proportional to the dynamic fluid viscosity and catheter length. Flow rates increase with larger catheter radius, use of more pressure (gravity, manual push-pull devices, pressure bag application, or commercial rapid infusing devices), decreasing viscosity (co-administration of crystalloid with viscous blood products), or decreasing catheter length (peripheral angiocatheter vs triple-lumen catheter). Flow rates are maximized by using the largest internal diameter catheter possible.
Peripheral Venous Anatomy of the Upper Extremity
The most commonly accessed veins for peripheral catheterization of the upper extremity are the dorsal hand veins and the veins of the antecubital fossa (Figure 1).
Venous anatomy of the upper extremity.
Peripheral catheterization of the superficial veins of the lower extremity can require cutdown of the great and small saphenous veins. The femoral vein is the primary deep vein of the lower extremity. It is located medial to the femoral artery.
Technique for Peripheral Venous Access
Gather all equipment before beginning the procedure (Table 1). Observe universal precautions. The procedure for peripheral IV line insertion is summarized in Table 2.
Table 1 Materials for Peripheral IV Line Placement |Favorite Table|Download (.pdf)
Table 1 Materials for Peripheral IV Line Placement
|Personal protective equipment (gloves, face shield)|
|Alcohol swabs or povidone iodine|
|Appropriate-sized venous catheter|
|IV solution and tubing (if indicated)|
|2 × 2 gauze|
|Sterile transparent dressing|
Table 2 Peripheral IV Line Insertion |Favorite Table|Download (.pdf)
Table 2 Peripheral IV Line Insertion
|Apply tourniquet.||Apply tourniquet tightly enough to facilitate adequate venous filling and distention without causing patient discomfort or ischemia.|
Inspect and palpate the vein.
Warm the skin, tap the vein, or apply topical nitroglycerin ointment to ease identification.
|Clean area with either an alcohol swab or povidone iodine solution.||—|
|Apply gentle traction with the nondominant hand to anchor the vein.||—|
|Insert catheter needle into skin and vessel at a 15- to 30-degree angle with dominant hand.||Peripheral veins are easiest to access at the apex of the “Y” formed by merging veins or where veins are straight for several centimeters.|
|Use a more obtuse (60-degree) angle for deeper veins.|
|Observe for blood flash in catheter hub.||This indicates successful vessel ...|