Peripheral IV Access
Key Points
- Start with systematic vein assessment in upper extremities and choose the least risky site that meets infusion goals.
- Match catheter gauge and device type to therapy needs, vessel size, and life-span factors.
- Monitor frequently for local and systemic complications and intervene immediately when abnormalities appear.
Equipment
- Peripheral IV catheter (commonly 18-22 gauge based on patient and therapy)
- Tourniquet or blood pressure cuff for short vein-dilation use
- Antiseptic supplies, dressing, and securement device (stat lock, chevron tape, arm board/wrap)
Procedure Steps
- Assess veins visually and by palpation from hand upward, including dorsal surfaces, then select the best site with a straight, resilient segment (improves first-pass success).
- Avoid high-risk sites and limbs with restrictions (mastectomy/lymph node dissection side, AV fistula arm, edema, scarred skin, recent failed puncture area).
- Choose catheter size and type based on purpose of access: larger diameter for rapid fluid or blood products, smaller gauge for fragile or pediatric vessels.
- Prepare and insert using facility aseptic workflow; never override safety-lock needle mechanisms and immediately dispose of sharps after attempt.
- Secure site, begin therapy, and perform scheduled reassessment and maintenance (site checks, flushing, dressing changes, and escalation for complications).
Common Errors
- Repeated attempts by the same clinician beyond two insertions → increased pain, delayed therapy, and reduced future access options
- Inadequate securement or infrequent reassessment → higher risk of infiltration, dislodgement, and preventable adverse events
Related
- infiltration-and-extravasation - Immediate recognition and stop-infusion response are core IV safety actions.
- catheter-related-bloodstream-infection - Strict hand hygiene and aseptic maintenance reduce CR-BSI risk.