Peripheral IV Access

Aka: Peripheral IV Access, Peripheral Catheterization, Peripheral Venous Catheterization, Peripheral Intravenous Catheter, Peripheral Vascular Catheter

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II. Types: Needles

  1. Over the Needle Catheter (Preferred)
    1. Age < 1 year: 22, 24 gauges
    2. Age 1-8 years: 18, 20, 22 gauges
    3. Age >8 years: 16, 18, 20 gauges
    4. Large Bore: 14-16 gauge
  2. Butterfly Needle
    1. Newborn: 23-25 gauges
    2. Age <8 years: 23, 21, 20 gauges
    3. Age >8 years: 21, 20, 18 gauges

III. Types: Sites

  1. Upper Extremity: Antecubital
    1. Cephalic Vein (lateral Forearm)
    2. Median cubital vein
    3. Basilic Vein (medial Forearm)
  2. Lower Extremity
    1. Great Saphenous Vein
      1. Descends through medial leg and ankle
      2. Lies anterior to medial malleolus
      3. Extends over dorsum into dorsal venous arch
    2. Median Marginal Vein
  3. Scalp
    1. Small superficial veins
    2. Not recommended in Resuscitation

IV. Technique

  1. Consider Local Anesthesia at catheter insertion site
    1. See Difficult Intravenous Access in Children
    2. Subcutaneous 1% Lidocaine 5 minutes before
    3. Topical Lidocaine (ELA-Max, LMX) occluded 30 min. before
    4. J-Tip (transdermal Lidocaine device)
    5. Luhmann (2004) Pediatrics 113:e217-20 [PubMed]
  2. Consider limb warming prior to IV cannula insertion
    1. Mitt for hand and Forearm warmed to 125 F (52 C)
    2. Increases success rate and decreases insertion time
    3. Lenhardt (2002) BMJ 325:409-10 [PubMed]
  3. Immobilize the extremity
  4. Locate and stretch the vein
    1. Soft roll of gauze to hyperextend the elbow
    2. Flex the wrist to extend the dorsal hand veins
    3. Extend the ankle to extend the dorsal foot veins
  5. Consider Ultrasound guidance for difficult IV starts
    1. Ultrasound is helpful for difficult IVs, but interferes with placement of easy IV starts
    2. McCarthy (2016) Ann Emerg Med 68(1): 10-8 +PMID: 26475248 [PubMed]
  6. Apply a Tourniquet to proximal vein
    1. Consider Blood Pressure cuff (inflated to 150 mmHg on arm)
      1. Very effective at maintaining non-compressible veins for peripheral vein cannulation
      2. Kule (2014) J Emerg Med S0736-4679(13) [PubMed]
  7. Antiseptic to cannulation site
  8. Flush the needle catheter with sterile saline
  9. Enter Skin
    1. Puncture distal to the site
    2. Enter at 45 degrees with bevel down
    3. Pull the skin to the side while entering skin
    4. Avoid entering the vein with needle
  10. Cannulate vein
    1. Slowly advance catheter/needle until free Blood Flow
    2. Advance catheter/needle a few millimeters
    3. Advance the remainder of the catheter of needle
  11. Remove the needle and confirm backflow
  12. Remove the Tourniquet
  13. Secure intravenous catheter
    1. Consider Skin Glue (Tissue Adhesive, Dermabond)
      1. One drop over skin entry and one drop under plastic hub
      2. Decreases dislodgment risk
      3. Budgen (2016) Ann Emerg Med 68(2):196-201 +PMID: 26747220 [PubMed]
    2. Cover with Transparent Film Dressing (e.g. Tegaderm)

V. Technique: Difficult IV Access

  1. See Intraosseous Access
  2. See Ultrasound-Guided Internal Jugular Vein Catheterization
  3. See Ultrasound-Guided Antecubital Line
  4. External Jugular Vein Catheterization
  5. Tourniquet Infusion Technique
    1. Obtain distal IV Access (e.g. 22 gauge) in a small hand vein or similar
    2. Apply Tourniquet above the elbow
    3. Infuse 100 cc Normal Saline into the hand vein to result in arm vessel engorgement
    4. Place standard size (e.g. 18 gauge) IV into one of the proximal engorged Forearm or antecubital veins
  6. Central Vein Placement of peripheral IV
    1. Identify a central vein for access (e.g. internal Jugular Vein) via Ultrasound
    2. Use a long peripheral catheter (48 mm is ideal if available, or use the angiocatheter in the Central Line kit)
    3. Sterilize the region
    4. Cannulate the vessel at a shallow angle with peripheral catheter under Ultrasound guidance
    5. Remove peripheral catheter within 72 hours

VI. References

  1. Strayer in Herbert (2018) EM:Rap 18(8): 16-7
  2. Quinn (2014) Emerg Med J 31(7): 593 [PubMed]
  3. Maayedi (2009) J Emerg Med 37(4): 419 [PubMed]

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Related Studies

Ontology: Catheterization, Peripheral (C0007436)

Definition (MSH) Insertion of a catheter into a peripheral artery, vein, or airway for diagnostic or therapeutic purposes.
Concepts Therapeutic or Preventive Procedure (T061) , Diagnostic Procedure (T060)
MSH D002406
English Catheterization, Peripheral, Catheterizations, Peripheral, Peripheral Catheterization, Peripheral Catheterizations, PERIPHERAL CATH, CATH PERIPHERAL, peripheral catheterization
Swedish Kateterisering, perifer
Finnish Perifeerinen katetrisaatio
Russian KATETERIZATSIIA PERIFERICHESKAIA, KATETERIZATSIIA PERIFERICHESKAIA ARTERIAL'NAIA, KATETERIZATSIIA PERIFERICHESKAIA VENOZNAIA, PERIFERICHESKAIA KATETERIZATSIIA, KATETERIZATSIIA BRONKHIAL'NAIA, КАТЕТЕРИЗАЦИЯ БРОНХИАЛЬНАЯ, КАТЕТЕРИЗАЦИЯ ПЕРИФЕРИЧЕСКАЯ, КАТЕТЕРИЗАЦИЯ ПЕРИФЕРИЧЕСКАЯ АРТЕРИАЛЬНАЯ, КАТЕТЕРИЗАЦИЯ ПЕРИФЕРИЧЕСКАЯ ВЕНОЗНАЯ, ПЕРИФЕРИЧЕСКАЯ КАТЕТЕРИЗАЦИЯ
Japanese 動脈カテーテル-末梢, 末梢静脈カテーテル, 末梢動脈カテーテル法, カテーテル法-末梢動脈, 気管支カテーテル, 静脈カテーテル-末梢, 静脈カテーテル法-末梢, カテーテル法-末梢, カテーテル-末梢, 動脈カテーテル法-末梢, 末梢カテーテル, カテーテル-末梢動脈, カテーテル法-気管支, 末梢静脈カテーテル法, カテーテル-末梢静脈, カテーテル法-末梢静脈, 末梢動脈カテーテル, 気管支カテーテル法, カテーテル-気管支, 末梢カテーテル法
Polish Cewnikowanie obwodowe żył, Cewnikowanie obwodowe, Cewnikowanie obwodowe tętnic, Cewnikowanie oskrzelowe
Czech periferní katetrizace, katetrizace periferní
Norwegian Kateterisering, perifer, Perifer kateterisering
French Cathétérisme périphérique
German Katheterisierung, periphere, Periphere Katheterisierung
Italian Cateterismo periferico
Dutch Catheterisatie, perifere, Katheterisatie, perifere
Portuguese Cateterismo Periférico
Spanish Cateterismo Periférico
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Peripheral Venous Catheterization (C0031127)

Concepts Therapeutic or Preventive Procedure (T061)
MSH D002406
English Catheterization, Peripheral Venous, Catheterizations, Peripheral Venous, Peripheral Venous Catheterizations, Venous Catheterization, Peripheral, Venous Catheterizations, Peripheral, CATH PERIPHERAL VENOUS, PERIPHERAL VENOUS CATH, VENOUS CATH PERIPHERAL, Peripheral Venous Catheterization
Czech katetrizace periferních vén
German Katheterisierung, periphere venöse, Venöse Katheterisierung, periphere
French Cathétérisme périphérique veineux
Norwegian Perifer venøs kateterisering, Kateterisering, perifer venøs
Italian Cateterismo venoso periferico
Dutch Katheterisatie, perifere veneuze
Portuguese Cateterismo Venoso Periférico
Spanish Cateterismo Venoso Periférico
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Peripheral intravenous catheter (C0179768)

Definition (UMD) Infusion catheters designed for insertion in percutaneously accessible blood vessels of the extremities (i.e., the peripheral vasculature) and are short in length to keep their distal tip near the insertion site. These catheters typically include a 2 to 8 cm (1 to 3 inches) plastic tube with a metal stylet inside its lumen (over-the-needle catheters). Peripheral infusion catheters are the most commonly used infusion devices for short dwelling time (typically seven days or less) administration of non-irritating fluids, electrolyte, vitamins, medication, and for the injection of certain anesthetics into the peripheral vasculature of patients with good venous access.
Concepts Medical Device (T074)
SnomedCT 82449006
English Catheters, Vascular, Infusion, Peripheral, Peripheral Infusion Catheters, Catheters, Intravenous, Peripheral, Peripheral intravenous catheter, device, peripheral intravenous catheter, peripheral intravenous catheter (treatment), peripheral IV line, catheters iv, peripheral intravenous catheters, IV catheter, Peripheral intravenous catheter, device (physical object), Peripheral intravenous catheter
Spanish catéter intravenoso periférico (objeto físico), catéter intravenoso periférico
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Peripheral vascular catheter (C2959441)

Concepts Medical Device (T074)
SnomedCT 446559007
English Peripheral vascular catheter, Peripheral vascular catheter (physical object)
Spanish catéter vascular periférico, catéter vascular periférico (objeto físico)
Derived from the NIH UMLS (Unified Medical Language System)

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