Registered Nurses' Association of Ontario

Selection of the Site for Peripheral Venous Access Device (PVAD) Insertion

  • When selecting a site for a peripheral venous access device (PVAD) insertion, the nurse should:
    • Avoid areas of flexion
    • Avoid the inner aspect of the wrist in order to decrease the risk of damage to the radial, ulnar, and/or median nerves which are located within a five centimetre (cm) radius of the inner aspect of the wrist
    • Avoid the routine use of the veins of the lower extremities due to the increased risk of embolism, thrombophlebitis of and infection
    • Choose the smallest gauge catheter to accommodate the prescribed therapy
    • Choose a vein with a diameter and blood flow rate for adequate hemodilution of prescribed therapy.
    • Venous blood flow rates to be considered are as follows:
      • Dorsal arch for metacarpal veins (hand veins) diameter varies, with flow rate 10ml/min;
      • Cephalic vein: 6mm diameter with flow rate 40ml/min at the level of the antecubital fossa and above; and
      • Basilic vein: 8mm diameter with flow rate of 95ml/min at the level of the antecubital fossa and above.

        To view a visual depiction of site location click here (Appendix C from the Guideline: Vein Anatomy & Blood Flow Rates, for a visual depiction of site location). 

    • Avoid the the antecubital fossa and metacarpal veins if a vesicant has to be peripherally delivered due to the difficulty in detecting infiltration at these sites of flexion.
    • Assess the type of solution, pH, osmolarity, estimated volume of the infusate and vein condition prior to selecting an alternative site due to infiltration/extravasation.
Clinical Management
Care and Maintenance to Reduce Vascular Access Complications
Point of Care Resources