Starting peripheral I.V.s: Tips for planning ahead

Nursing, Apr 2003 by Trimble, Tom

STARTING PERIPHERAL I.V. devices is a basic nursing responsibility. To plan a successful I.V. start, ask yourself:

How long is access needed? If I.V. therapy may last more than a week, consider a midline catheter or central vascular access device, such as a peripherally inserted central catheter. If the patient needs long-term therapy, he may need a central vascular access device, such as a tunneled catheter. Evaluate the patient's I.V. therapy needs early in his hospitalization or therapy so that usable vessels are still available for emergencies or when vascular access devices must be replaced. Don't use small veins to infuse irritants or vesicants.

Right or left? When feasible, insert the I.V. device into the arm on the patient's nondominant side; it's usually more convenient. (Be sure to ask him which side he'd prefer.) But if he has few suitable veins, you may find better ones on his dominant arm; because ifs exercised more, it has more collateral circulation. Don't use the wrist, antecubital fossa, and other flexion sites, which are vulnerable to infiltration and mechanical and nerve injuries.

Avoid an arm with an injury, loss ot sensation, or arteriovenous fistula. Also don't insert an I.V. device on the same side as a mastectomy or axillary node removal or on a side affected by stroke. In adults, avoid leg sites because of the risk of phlebitis.

Out of the way? If, however, you know the patient is scheduled for surgery or another major procedure, insert the LV. device on the contralateral side so that the surgical team has clear access to the surgical site.

What size device? Think small: Use the smallest gauge and the shortest length cannula in the largest vein if possible. The Infusion Nurses Society offers these general recommendations:

* a 24- to 22-gauge cannula for children and elderly patients

* a 24- to 20-gauge cannula for medical and postoperative surgical patients

* an 18-gauge cannula for surgical patients and for rapid blood administration

* a 16-gauge cannula for trauma patients and those who need rapid infusions of large volumes of fluid.

Tom Trimble is a staff nurse in the emergency department at the University of California at San Francisco Medical Center and webmaster of the Emergency Nursing World Web site. This article was adapted with permission from "I.V. Starts: Improving Your Odds," http://enw.arg.