Peripheral venous access refers to a vascular catheter that terminates in a peripheral vein in an extremity, the scalp, or trunk. Indications may include IV fluid therapy, blood sampling, and medication administration. Contraindications include infection, tissue compromise, and thrombosis. It is important to determine the best site for insertion, select the right catheter size, and ensure all necessary equipment is at the bedside before performing the procedure. IV infiltration and IV extravasation are common complications.
- Determine the best site for insertion. 
- Select the appropriate catheter size. 
- Consider local anesthesia for the insertion site. 
- Ensure all necessary equipment is at the bedside.
- Place a tourniquet 5–10 cm above the site of insertion.
- Prepare the site with an antiseptic solution.
- Apply traction to the skin with the nondominant hand.
- Direct the needle into the vein at a 10–30° angle with the bevel facing upward.
- Advance until blood flashback is seen.
- Depress the angle of the needle and advance another 1–2 mm.
- Slide the catheter off the needle.
- Flush with saline or aspirate blood.
- Apply a sterile dressing.
- Infiltration or extravasation: leakage or unintentional administration of solution or medication into the tissue surrounding a PIV catheter
- IV infiltration: involves a nonvesicant substance (e.g., saline)
- IV extravasation: involves a substance
- Inadvertent intraarterial placement
- Infection and/or thrombophlebitis
- Patient discomfort
We list the most important complications. The selection is not exhaustive.
- Tourniquet removed
- Sharps properly disposed of
- Sterile dressing applied
- Catheter placement verified
- IV function confirmed
- or ruled out
|Common pitfalls in peripheral intravenous line placement |
|Challenge||Interventions to consider|
|No visible vein|
|Needle does not enter vein|
|Catheter does not advance|| |
|Fluid does not run|| |