IV Sites to Avoid
Administering IV fluids or medications to a patient requires special care and safety measures by the nurses. This is to prevent IV site complications and prioritize the patients' overall well-being. So, knowing what IV sites to avoid is crucial during nutrient administration.
In addition to learning where not to put an IV, nurses must also identify signs and symptoms of potential complications. This way, they will adequately administer the therapy and potentially obtain effective results.
The choice of IV injection site may depend on the patient’s condition, age, diagnosis, skin condition, type, and duration of infusion therapy. In this article, we listed the most unsafe IV placements and described their possible associated health problems.
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What IV Sites to Avoid
Nurses select an appropriate IV catheter and size, establish IV access, and monitor for potential complications during the administration of infusion therapy. A mobile infusion nurse must also follow general guidelines for maintaining the safety of the chosen venous access sites.
IV sites that nurses commonly avoid include compromised veins that may have bruises and infections. Also, if they observe that a vein is engorged or infiltrated, they consider it an improper IV site for therapy administration.
They must comprehensively search for a vein, identify it, and insert the needle. Usually, they choose veins in the upper extremities, like the hands and arms, because they are typically the preferred sites for IV insertion.
Nurses must also assess the potential of the vessels for insertion, examining possible injection sites. They should take their time to find the best access site because this practice may decrease the discomfort and pain for the patient.
They usually start examining the veins in the arms before delivering the IV therapy. But they can also identify a vulnerable site that may complicate the IV access. Let’s learn what IV sites to avoid during infusion treatments.
The palmar side of the wrist veins
Veins on the wrist palmar side are well-known IV sites to avoid because they may cause potential nerve damage. They are smaller hand veins than the arm's cephalic, basilic, or brachial veins. Thus, if a patient requires an infusion of fluid, a large-gauge IV cannula is usually placed in a large vein in the upper arm.
Areas with valve presence
When looking for a potential site for IV cannulation, nurses must consider how easy the access of the vein is. Suitable IV access sites include veins that feel resilient to the touch. Yet, not all veins are like this.
Some of them tend to bifurcate and divide into branches that appear narrow or curved. This makes them difficult to access. So, if nurses locate vein bumps that indicate valves, they should avoid placing the IV in this area.
The extremities with restrictions
Proper vein selection for IV placement may include avoiding extremities with restrictions. These are usually extremities that have been subjected to conditions like mastectomy, lymph node dissection, the presence of an assistive device, or those with reduced sensation.
The presence of an IV in restrictive extremities may increase the risk of localized infection and other similar complications that might negatively affect the patient's health.
Sites below a recent venipuncture
Nurses must also consider the patient’s skin condition before selecting an IV access site. If the skin has scars, needle penetration may become tough and cause discomfort. Sites below a recent venipuncture should also be avoided due to the potential for fluid leaking out of the site.
Tattooed skin or extremities with edema
Some factors make it difficult for nurses to identify veins and assess for potential signs of complications. They might be unable to identify cannula misplacement or fluid leakage if the patient's skin is tattooed or if they have extremities with edema. So, nurses avoid the administration of IVs in these areas.
Areas of flexion and pain
The wrist’s ventral surface is one of the IV sites to avoid due to the possibility of causing nerve damage. Areas of flexion and painful sites on palpation should also be avoided to prevent the patient from experiencing extreme discomfort.
Compromised areas with wounds and infections may also undergo severe pain if an IV is placed on them. The same applies to areas of previous infiltration or extravasation and sites of planned procedures.
The veins in an upper extremity on the side of breast surgery
Veins in the upper extremity on the side of breast surgery may have axillary node dissection with lymphedema or an arteriovenous fistula. Thus, the nurse observes that this extremity has been affected and avoids using a vein in this area to administer IV therapy.
Lower limbs
The upper limbs of the human body are commonly used for IV therapy administration, unlike the lower limbs. If possible, nurses tend to avoid IV insertion in lower limbs due to the risk of developing thrombosis and the possibility of causing limited mobility.
Areas with known neurologic impairment
Small and fragile veins in areas of flexion and known neurologic impairment are not ideal IV access sites. Seizure symptoms of patients with residual neurological impairments are commonly considered a relative contraindication of IV insertion.
Tips for Safe Administration of IV Therapy
Let’s shift our focus to learning safe IV cannulation practices. Even though infections from IV therapy administration are rare, nurses must be careful to avoid serious health problems like infiltration, causing redness and swelling around the injection site.
Use the proper equipment
Nurses need to use the required equipment to ensure proper IV administration. The necessary tools for inserting an IV infusion include gloves, alcohol swabs, a cannula, and syringes in case of emergency blood work.
Choose the appropriate needle size
A large variety of cannula sizes can be used for different purposes. Nurses must identify the patient’s condition before choosing the appropriate needle size. There are IV injections for fragile veins, surgery, blood work, everyday administration of fluids and antibiotics, as well as those for rapid infusion of IV therapy.
Identify a vein
When identifying a vein, nurses must consider multiple factors. Ideally, the vein for IV access should be large, and the placement of the cannula should not prevent movement. Usually, they look for veins in the forearm and ask the patient to pump their fist to make the vein more visible.
Focus on proper insertion
Before the process of IV insertion can begin, nurses must ask the patients for their consent and explain the entire procedure. Nurses must work with clean hands and sterilized equipment to prevent possible infections around the injection site.
Getting the patient in a proper position is crucial during IV insertion. Nurses must ensure the limb is elevated for the easiest administration. Before delivering the injection, they swab the site with alcohol and let it air dry.
Then, they stretch the skin to the insertion site and inform the patient that they might feel a slight pinch. The needle is inserted bevel up or 30 degrees from the skin. Then, it is flattened and advanced by 2mm while holding it still.
If the nurse observes that a patient is likely to move, they place an elastic or woven bandage to cover the injected part of the limb. Then, they dispose of sharps and other waste, remove their gloves, and wash their hands. They also document the cannula insertion, including the date, site, and number of attempts.
Monitor the patient
After a patient receives IV therapy, nurses must monitor their vital signs in case they develop a reaction to the treatment. Local and systemic complications around the injection site may occur during the administration of IV therapy.
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Frequently Asked Questions
What is the easiest vein to insert an IV?
The preferred sites for IV insertion include the hand, wrist, and cubital fossa. The main arm veins are cephalic, basilic, and median cubital veins. These are the easiest to access intravenously due to their relatively large size.
What is the best site for IV injection for adults?
For adults, the best IV injection sites usually include the forearm and outer surface of the hand. Less commonly, but possible if there is no other option, they might be injected into the outer surface of the foot. Urgent situations may call for IV injection in the veins of the cubital fossa and external jugular veins.
Are the recommended IV sites for adults the same as for infants?
Nurses may recommend different IV sites for babies because they are more delicate and vulnerable than adults. Babies might usually have an IV catheter placed in a hand, foot, scalp, or any area that can be easily accessed.
Conclusion
With careful attention and skill, nurses can recognize which IV sites to avoid during therapy administration. They are also trained in preventing and managing complications of IV therapy.
Thus, proper insertion and monitoring ensure that medical professionals prioritize patient safety. This way, patients might enjoy the benefits of getting IV infusions instead of worrying about possible IV site complications.
