IV therapy is an essential medical technique, used on a daily basis in hospitals and other healthcare settings around the world. It’s one of the most effective ways to deliver fluids, medications, and nutrients into a patient’s body, and it has countless uses. But, in order to be effective, IV therapy needs to be performed correctly, with the most appropriate insertion site selected each time.
What is an IV Insertion Site?
An IV insertion site is simply a part of the body where the IV lining is initially inserted. This is the part of the body where a needle will be used to puncture the skin and a cannula will typically be put into place to guide the IV tubing into the body and allow for infusion to occur. An IV insertion site needs to provide direct access to a Vein, and there are many potential IV insertion sites all around the body, although some are used much more commonly than others.
Common IV Sites For Adults
In general, most IV insertions will be done in adults. There are many different reasons why an adult may require an IV line; it could be to replenish their bodies with fluids after dehydration, or to deliver vital medications into their bloodstream. In any case, there are several key areas in which IV lines are usually inserted in adult patients. Here are some of the most common options:
1. Dorsal Venous Network
The Dorsal Venous Network, otherwise known as the dorsal veins, are the superficial veins that are located on the back of the hand. They’re one of the best locations for IV insertion in adults, but it’s important for the patient to keep still and usually form a fist to prevent the veins moving around.
2. Median Antebrachial Vein
Also simply known as the median vein of the forearm, this is the vein that runs from the palm of the hand across the wrist and along the inner section of the forearm. It’s a good vein for IV insertion with narrow gauge catheters.
3. Accessory Cephalic Vein
This is a vein that runs off from the main cephalic vein. It’s also found in the arm, around the elbow area, and is well-suited to quite narrow catheters like 20 or 22 gauge IV lines.
4. Median Cubital
Finally, we have the median cubital vein, situated in the bend of the arm and the meeting point of the basilic and cephalic veins. It’s a very large vein and is usually quite easy to access, but because it’s near a joint, it can be impactical for long-term IV therapy and is generally more of a last resort choice when the above options are not viable.
Common IV Sites For Neonates
There are some cases in which neonates, or newborn babies, require potentially life-saving infusion therapy immediately after being born. Inserting an IV into a neonate is something that needs to be carried out with great care, but there are several vein sites that are relatively easy to access in neonates, especially in the hands and feet. It’s important to try and find a site with a relatively straight vein and no bruising. Here are some of the main sites that are usually chosen:
1. Dorsal Venous Network
The dorsal venous network is a good place to try when inserting an IV into a neonate. Skin entry is relatively easy here but it’s important to avoid the feeder veins that run over the dorsum.
2. Accessory Cephalic Vein
The Accessory Cephalic Vein is another option to consider for neonates.
3. Volar Aspect
It’s relatively easy to see and find veins on the volar aspect of the wrist in neonates, but this isn’t a great place for long-term use.
4. Median Cubital
The median cubital or median antecubital is another common option for neonates, along with the other veins in the cubital fossa, or inside the elbow.
5. Feet
Veins in the feet, like the saphenous or dorsal arch veins, may be used in neonates, too. They offer easy access, but need to be handled with care, as the risks of infiltration are quite high.
Common IV Sites For Infants
Inserting IV lines into infants is quite similar to the process for neonates. Like neonates, infants, or very young children and babies, require high levels of care during infusion procedures, but may need to have IV lines to provide their bodies with essential fluids, nutrients, and medications to fend off certain illnesses or treat other health conditions. Here are some of the main IV insertion sites that are typically used with infants:
1. Dorsal Venous Network
Dorsal veins work well as insertion sites in people of all ages, including infants. A narrow gauge catheter should be used to reduce the risk of any injuries.
2. Accessory Cephalic Vein
The accessory cephalic vein works well for infants thanks to its visibility and convenience.
3. Median Cubital
The median cubital, situated in the depression inside the elbow, is a good vein to use for IV therapy in infants.
4. Volar Aspect
The wrist may be used for short-term IV therapy in infants, but isn’t the best option for long-temr therapy.
5. Feet
Two veins in the feet may also be used – the saphenous vein near the ankle and the dorsal arch veins on the top of the foot.
Common IV Sites For Pediatrics
For children, or pediatric patients with bodies that are more developed than infants, the process of inserting an IV is quite similar to putting an IV into an adult patient, and the most common sites are also very similar. Here are some of the most common IV insertion sites for pediatric patients:
1. Dorsal Venous Network
In children, too, the dorsal venous network is a good choice for inserting an IV, thanks to the easy identification and access to the veins.
2. Accessory Cephalic Vein
The accessory cephalic vein is also a good choice for pediatric patients as it is usually quite easy to see and get to.
3. Median Cubital
The median cubital works well for pediatric patients and usually lasts quite well.
Common IV Sites For The Elderly
There can be some problems when it comes to inserting IV lines into elderly patients. In general, the most common IV insertion sites will be the same for these patients as they would for younger adults. However, older patients may have weaker vein walls and thinner skin, which can make the insertion process more painful and lead to a higher risk of blown veins, bruising, or difficulty accessing the veins in the first place. Here are some of the main insertion sites used for elderly individuals:
1. Median Antebrachial Vein
In general, elderly patients tend to require narrower gauge catheters, and the median vein of the forearm is well-suited to these kinds of catheters, so it’s a good choice with older patients.
2. Accessory Cephalic Vein
The accessory cephalic vein is also well-suited to the narrow catheters that tend to be used in elderly individuals.
3. Dorsal Venous Network
The dorsal veins are another option to consider with elderly patients, but the veins can roll a lot in older people, so precision is very important when inserting an IV here.
Are There IV Sites to Avoid or Use as a Last Option?
As seen above, there are several viable IV insertion sites for each and every age group, from neonates right up to elderly individuals. If one site is not viable for some reason, another appropriate site can be selected.
However, identifying and choosing IV insertion sites has to be done on a case-by-case basis, and sometimes, various factors may mean that one site could be riskier or should be avoided, if possible.
For example, in neonates and infants, the median antecubital veins are best avoided when you’re preparing for long-term IV therapy. The saphenous vein and superficial temporal vein are also best avoided for long-term IV situations.
Some of the so-called “last resort” locations for an IV insertion would be in the fingers, the shoulder, the feet, the scalp, or the ankles. These locations may be viable in some cases but are not recommended in most situations.
In general, for each patient, practitioners should always aim to insert in the safest and most practical location. If this isn’t possible, they can move down the list of other insertion sites until they find a viable option.
How to Assess & Prepare an Insertion Site For IV
Before IV insertion, a medical practitioner will need to assess the patient and determine the most ideal site of insertion, as well as preparing the site before the tubing is inserted. Here’s a simple step-by-step guide of how to assess and prepare IV insertion sites.
Step 1. Assess the Patient
The first step is to assess the patient and gather information to decide on the right site to use for insertion. The patient’s age will be a major factor in this, as different sites are usually chosen for people of different ages.
It’s also important to think about what drugs the patient will be given, or whether they’ll be given blood products, as well as the patient’s medical history, as all of this will determine the right site for insertion.
Step 2. Prepare the Essentials
Once a site has been selected, the nurse or doctor should prepare all of the necessary items for the insertion process, including gloves, cleaning wipes, the IV cannula and tubing, a syringe, solution, and so on.
Step 3. Clean Your Hands and Prepare the Patient
Next, the medical practitioner should make use of an alcohol cleanser or other cleaning solution to sanitize their hands and then get the patient ready for insertion by telling them where the IV will be inserted. In most cases, this will be in the arm, so you should prepare the patient’s arm in a position that is comfortable for them and allows you to identify and access a vein.
Step 4. Apply a Tourniquet and Palpate
A tourniquet should then be applied above the insertion site. This will help the vein to become more visible and easier to access. If it’s not possible to use a tourniquet, or if the vein is still hard to see, palpating the area may also help to make the vein easier to get to.
Step 5. Clean the Site
Wearing medical gloves and using a fresh alcohol or medical wipe, clean the patient’s skin around the planned insertion site, and give it time to dry off. You can then proceed to the next steps of actually inserting the needle and cannula. After insertion, it’s important to continue monitoring the site to look for any possible complications, such as redness, swelling, rashes, edema, or other issues.
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