Chapter 31: Vascular Access

INTRODUCTION

Multiple factors determine the route and site for vascular access, and knowing the basic anatomy, techniques, indications, and contraindications is essential.

Infusion rate is key in the resuscitation of those with severe hypovolemia or hemorrhage.¹ 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 (coadministration of crystalloid with viscous blood products), or decreasing catheter length (peripheral angiocatheter vs. triple-lumen catheter). Maximal flow rates occur from shorter and wide catheters, although both may be hard to achieve.

PERIPHERAL VENOUS ACCESS AND ANATOMY

The most commonly accessed veins for peripheral catheterization of the upper extremity are in the dorsal hand and the antecubital fossa (Figure 31-1).

Peripheral catheterization of the superficial veins of the lower extremity is possible, sometimes overlooked, and occasionally more difficult. Avoid IV access of the lower extremity in adults, especially diabetics, due to an increased risk of infection and phlebitis. See discussion below of venous cutdown of the saphenous vein at the medial malleolus.

TECHNIQUE FOR PERIPHERAL VENOUS ACCESS

Gather all equipment before beginning the procedure (Table 31-1). Observe universal precautions. The procedure for peripheral IV line insertion is in Table 31-2.