Emergency Medicine Book

http://www.fpnotebook.com/

Peripheral IV Access

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  1. Needle Types
    1. Over the Needle Catheter (Preferred)
      1. Age < 1 year: 22, 24 gauges
      2. Age 1-8 years: 18, 20, 22 gauges
      3. Age >8 years: 16, 18, 20 gauges
    2. Butterfly Needle
      1. Newborn: 23-25 gauges
      2. Age <8 years: 23, 21, 20 gauges
      3. Age >8 years: 21, 20, 18 gauges
  2. Sites
    1. Upper Extremity
      1. Cephalic Vein (lateral forearm)
      2. Median cubital vein
      3. Basilic Vein (medial forearm)
    2. Lower Extremity
      1. Great Saphenous Vein
        1. Descends through medial leg and ankle
        2. Lies anterior to medial malleolus
        3. Extends over dorsum into dorsal venous arch
      2. Median Marginal Vein
    3. Scalp
      1. Small superficial veins
      2. Not recommended in Resuscitation
  3. Technique
    1. Consider Local Anesthesia at catheter insertion site
      1. Subcutaneous 1% Lidocaine 5 minutes before or
      2. Topical Lidocaine (ELA-Max) occluded 30 min. before
      3. Luhmann (2004) Pediatrics 113:e217
    2. Consider limb warming prior to IV cannula insertion
      1. Mitt for hand and forearm warmed to 125 F (52 C)
      2. Increases success rate and decreases insertion time
      3. Lenhardt (2002) BMJ 325:409
    3. Immobilize the extremity
    4. Locate and stretch the vein
      1. Soft roll of gauze to hyperextend the elbow
      2. Flex the wrist to extend the dorsal hand veins
      3. Extend the ankle to extend the dorsal foot veins
    5. Apply a tourniquet to proximal vein
    6. Antiseptic to cannulation site
    7. Flush the needle catheter with sterile saline
    8. Enter Skin
      1. Puncture distal to the site
      2. Enter at 45 degrees with bevel down
      3. Pull the skin to the side while entering skin
      4. Avoid entering the vein with needle
    9. Cannulate vein
      1. Slowly advance catheter/needle until free blood flow
      2. Advance catheter/needle a few millimeters
      3. Advance the remainder of the catheter of needle
    10. Remove the needle and confirm backflow
    11. Remove the tourniquet

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