IV Site Selection

MonkeyArrow

MonkeyArrow

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So I was at a local hospital's employee health division getting blood drawn for a TB test. I have very good veins that are easily visible without a TQ and are springy to the touch without rolling or palpable valves in both forearms. However, the nurse choose to directly try to stick the AC which is considerable less visible without looking at other options. So I wondered, how do you guys pick IV sites? Do you specifically examine both arms or do you go straight for X (Ex.: right arm AC) etc.?
 
I always go or the most visible, one I know I (should) get on the first try. Also I usually start low and work my way up based off the above.

Not sure why she went straight for AC I try to avoid there because it occludes so easy when the pt bends their arm
 
If the forearm has something that's my first choice, all things being equal. Hurts less than the hand and less likely to accidentally occlude than the AC.

I try to start low and move up, but sometimes the AC is the one that I am reasonably sure I'll get the first try, so there it goes.
 
MonkeyArrow said:
So I was at a local hospital's employee health division getting blood drawn for a TB test. I have very good veins that are easily visible without a TQ and are springy to the touch without rolling or palpable valves in both forearms. However, the nurse choose to directly try to stick the AC which is considerable less visible without looking at other options. So I wondered, how do you guys pick IV sites? Do you specifically examine both arms or do you go straight for X (Ex.: right arm AC) etc.?
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The AC area is considered by many to be the least painful place for a stick and of course its often the easiest site anyway, so it is often where phlebotomists look first. They aren't leaving a catheter in, so there are no concerns with kinking or anything.

When I start a PIV I basically go for whatever looks easiest. All things being equal I prefer to go in the forearm, and generally have good luck with the cephalic or basilic veins below the elbow.
 
I start low at the hand and move up. If they look like a tough stick, but have a decent AC ill go there first, but I rarely stick AC's otherwise
 
I do the same. Start distal and work my way up the arm. I guess it depends on the person and situation. I'd say about 40% of the IV's start are AC and the rest are hand, fore arm, foot and the seemingly unappreciated EJ.
 
Wherever I want. :)
 
I've started all of maybe 70 IVs so I'm still a noob, but maybe 75% of mine have been AC. Why? Because its the easiest, it doesn't get any more complicated for me. That and ERs seem to prefer it there anyway in case they need to push some contrast, at least that's what I've been told.
 
Our ERs here hate ACs unless it's all we could get. They kink and they're uncomfortable. Proximal forearm if you think they're going to need to do contrast. Otherwise I go by what looks and feels good. I generally will do wrists or the lateral aspect of the forearm. Sure it might be more sensitive to the stick but after it's a better position for the IV. Keeps it so it's not resting between the arm and the bed, they can cross their arms, so on and so forth.
 
I tend to try for inner forearms with 18s as my go-to site. A little deep but easily anchored
 
I usually take a look at what the PT has and go from there. Heck I actually had to do a Pedal on Sunday on a 85yr old M.
 
On chest pain and SOB patients I usually go to the AC first off. All of our local hospitals that work someone up for PE, when they do the CTA with contrast, per radiology the contrast has to be pushed through a 20 gauge or bigger at the AC or higher, I really try and be thoughtful of that when starting lines on those type of patients. Other then that I usually aim for the most obvious non AC vein, If they have really crap veins in the hand and nothing else I usually start looking at their shoulder area just around the arm pit area and can usually find something there to put a 22 or a 20 in if they need it, I tend to have pretty good luck there
 
Typically I will try for the first easily visible vein at the lowest point I can find. I know that hospitals recommend "starting above the wrist", but if there is an easily accessible hand vein and I do not have to stick the AC, I will go for that.

I know many patients complain that "it hurts in the crease", so unless absolutely necessary- I try to avoid the AC.
 
The ER I worked in spared the antecubitus (aka "inside the elbow") if possible because if the pt went to Anesthesia latter, they would complain we used up their sites.
 
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