Indications
- • IV fluids / drugs
- • Blood sampling
- • Contrast
- • Resuscitation (2× large bore)
Contraindications
- ⚠ AV fistula limb
- ⚠ Limb with lymphoedema / mastectomy
- ⚠ Infection / burns at site
Equipment
- • Tourniquet
- • Chlorhexidine / alcohol wipe
- • Cannula 14–22 G
- • Saline flush 10 mL
- • Dressing, gauze, gloves
Technique
- • Select vein: forearm > dorsum hand > antecubital fossa for emergency
- • Apply tourniquet 10 cm proximal
- • Clean site for 30 s, allow to dry
- • Tension skin, insert cannula at 10–30° bevel up
- • Flashback in chamber → advance needle 2 mm → slide cannula off stylet into vein
- • Release tourniquet, remove stylet into sharps bin
- • Flush with saline — should be painless and free-flowing
- • Secure dressing, document size and site
Complications
- ⚠ Failed insertion / extravasation
- ⚠ Haematoma
- ⚠ Phlebitis (VIP score)
- ⚠ Infection, sepsis
- ⚠ Nerve injury (AC fossa)
Aftercare
- • Daily VIP score, replace if score ≥2
- • Resite every 72–96 h
- • Remove ASAP if not needed
Clinical pearls
- • For resus use 2× 14–16 G in AC fossa
- • Use USS for difficult access; intraosseous if 2 failed attempts in arrest
Perform under supervision until competent. Follow local SOPs and consent policy.
