Peripheral venous access

Last updated: November 10, 2022

Summarytoggle arrow icon

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.

Contraindications to this procedure in the limb or intended insertion site include: [1]

We list the most important contraindications. The selection is not exhaustive.

  • Determine the best site for insertion. [1][2]
  • Select the appropriate catheter size. [1]
  • Consider local anesthesia for the insertion site. [3]
  • Ensure all necessary equipment is at the bedside.

Select proximal insertion sites (e.g., antecubital fossae) to administer resuscitative fluids and medication (e.g., adenosine).

  1. Place a tourniquet 5–10 cm above the site of insertion.
  2. Prepare the site with an antiseptic solution.
  3. Apply traction to the skin with the nondominant hand.
  4. Direct the needle into the vein at a 10–30° angle with the bevel facing upward.
  5. Advance until blood flashback is seen.
  6. Depress the angle of the needle and advance another 1–2 mm.
  7. Slide the catheter off the needle.
  8. Flush with saline or aspirate blood.
  9. 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 vesicant substance
  • Inadvertent intraarterial placement
  • Infection and/or thrombophlebitis
  • Patient discomfort
  • Thrombosis

We list the most important complications. The selection is not exhaustive.

Common pitfalls in peripheral intravenous line placement [1][4][5]
Challenge Interventions to consider
No visible vein
  • Ensure tourniquet pressure is adequate.
  • Depress the insertion site below the heart and gently tap the vein.
  • Apply a warm compress or nitroglycerin ointment over the vein.
  • Visualize the vein with ultrasound or near-infrared.
Needle does not enter vein
  • Increase counter traction on the skin.
  • Change insertion site or position of the patient's arm.
  • Increase the angle of insertion.
  • Assess the vein for possible occlusion using ultrasound.
Catheter does not advance
  • Needle has not been removed: Advance the needle-catheter unit forward 1–2 mm.
  • Needle removed: Gently flush the catheter and attempt to float the catheter forward.
Fluid does not run
  • Ensure the tourniquet has been removed.
  • Withdraw the catheter 1–2 mm and reassess.
Patient discomfort
  1. Roberts JR. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. Elsevier ; 2018
  2. Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. Management of chemotherapy extravasation: ESMO–EONS Clinical Practice Guidelines. Ann Oncol. 2012; 23 : p.vii167-vii173. doi: 10.1093/annonc/mds294 . | Open in Read by QxMD
  3. Bond M, Crathorne L, Peters J, et al. First do no harm: pain relief for the peripheral venous cannulation of adults, a systematic review and network meta-analysis. BMC Anesthesiol. 2015; 16 (1). doi: 10.1186/s12871-016-0252-8 . | Open in Read by QxMD
  4. Mbamalu D, Banerjee A. Classic techniques in medicine: Methods of obtaining peripheral venous access in difficult situations. Postgrad Med J. 1999; 75 (886): p.459-462. doi: 10.1136/pgmj.75.886.459 . | Open in Read by QxMD
  5. Eren H. Difficult Intravenous Access and Its Management. IntechOpen ; 2022

3 free articles remaining

You have 3 free member-only articles left this month. Sign up and get unlimited access.
 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer