Peripheral Intravenous Line Access and Blood Sampling (2024)

To successfully perform peripheral IV cannulation, it’s important to use the correct technique and select an appropriate site with a visible vein.

• Start by applying heat and a tourniquet to enhance blood flow, making the vein more prominent.
• Once you have identified the vein, stabilize it and insert the cannula at an angle of 10 to 30 degrees, advancing it slowly while monitoring for proper placement.
• Finally, secure the cannula using a transparent dressing or tape, ensuring it is not too tight.

Proper care and maintenance of peripheral intravenous (IV) lines are crucial to prevent complications and ensure patient safety. According to evidence-based guidelines, dressing care plays a vital role in IV line maintenance. Transparent semipermeable dressings are recommended by the Infusion Nurses Society (INS) as they provide a barrier against contamination and allow easy visualization of the insertion site [11]. Regular inspection of the dressing is important to identify any issues such as loosening, soiling, or moisture accumulation, and compromised dressings should be promptly replaced using sterile technique to reduce the risk of infection.

Flushing and locking peripheral IV lines are essential for maintaining patency. The INS recommends flushing with 0.9% sodium chloride (normal saline) solution before and after medication administration and at least every 8-12 hours for continuous infusions [11]. This practice helps prevent blood clot formation and ensures proper line functioning. When intermittent infusion is not expected for an extended period, the INS suggests using a saline or heparin lock to maintain line patency [11].

Vigilant monitoring and assessment of the peripheral IV site are critical to detect any signs of infection or complications. According to the Centers for Disease Control and Prevention (CDC), routine site inspection should be performed at least daily, paying close attention to redness, swelling, warmth, tenderness, or drainage [12]. Timely reporting and appropriate intervention in case of any abnormalities are crucial to prevent complications like phlebitis or infiltration.

Patient education is an essential aspect of peripheral IV line care. Educating patients and their caregivers about proper hand hygiene, signs of infection or complications, and when to seek medical assistance is vital. Patients should receive clear instructions to promptly report any pain, tenderness, or changes at the IV site.

It is important to note that specific institutional protocols may vary, and adherence to local guidelines is essential. These recommendations are based on current evidence and best practices in peripheral IV line care, aiming to promote patient safety and achieve optimal outcomes.

There are some pitfalls to avoid. Failure to use proper technique or choosing an inappropriate site can increase the risk of infection and complications such as infiltration, extravasation, or phlebitis. Applying too much heat or pressure with the tourniquet can cause burns or damage to the veins. Failure to stabilize the vein or inserting the cannula at the wrong angle can make cannulation more difficult or cause complications. Advancing the cannula too quickly or over-tightening the dressing can cause pain or discomfort, restrict blood flow, or damage the vein.

In time-critical cases with known difficult peripheral access or where multiple attempts at peripheral line placement have already failed, an ultrasound-guided technique may be necessary, or the clinician may consider using alternative routes of drug administration (such as oral, intramuscular, intraosseous, or central venous access).