- 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.
Care and Maintenance to Reduce Vascular Access Complications
Point of Care Resources