Chapter 8. Peripheral IV Insertion

• • Vascular access in nonemergent situations or temporary access in emergent situations.

  • Administration of fluids and electrolytes.

  • Administration of intravenous medications.

  • Administration of blood and blood products.

  • Blood sampling.

Absolute

• • Do not insert through an infected site.

  • Do not insert through a burn.

  • Do not insert in an injured site.

Relative

• • Avoid a paralyzed extremity.

  • Do not insert in a massively edematous extremity.

  • Do not insert an IV distal to injured organs (eg, do not use lower extremities when treating abdominal injuries).

  • Avoid joint area.

• • Gloves.

  • Tourniquet or rubber band.

  • Tape and occlusive transparent dressing.

  • Alcohol wipes.

  • Povidone or chlorhexidine.

  • Syringe filled with injectable saline.

  • Gauze pads.

  • IV device: catheter or butterfly of appropriate size to fit the patient and the task.

  • Topical anesthetic cream.

• • Ultrasound guiding equipment (if available and if trained in its use).

• • Infection.

  • Hematoma.

  • Extravasation.

  • Compartment syndrome.

  • Severe vasoconstriction if vasoactive medications are infused through a peripheral IV and extravasate.

  • Venous thrombosis.

  • Embolization of air or catheter fragment.

• • Plan the procedure.

  • Limit the procedure time.

  • Have a backup plan.

  • Examine all possible sites carefully before choosing one.

  • Apply gentle circumferential pressure with 1 hand on the extremity to fill up the veins, which helps identify the most appropriate site.

  • In choosing the equipment and the site for the line, consider the patient’s needs.

  • • A trauma patient will require a large bore line, preferably a short one in order to avoid high resistance with high flows.

• • Introduce yourself to the parents and to the patient.

  • Explain to the parents and the child, if appropriate, the procedure and its purpose.

  • Choose 1 or more possible sites, and apply topical anesthetic cream.

  • Answer all of the parents’ and patient’s questions.

• • Position the patient with the chosen site closest to you.

  • Have a helper gently restrain and distract the child.

  • Have the patient at a comfortable working height.

  • For external jugular line placement, have the patient’s head lower than the trunk (Trendelenburg).

• • Accessible peripheral veins that are usually available include the following (Figure 8–1):

• • • On the dorsum of the hands.

    • On the radial side of the hand.

    • In the antecubital fossa.

    • The saphenous vein at the medial aspect of the ankle.

    • The dorsum of the feet.

    • External jugular vein.

  • In infants, additional sites include scalp veins.