Identify a suitable insertion site by taking into account the potential risk of infection, mechanical complications and patient comfort, preferably using veins in the non-dominant arm. Ask the patient if they have a preference for the location of the PIVC, and follow their preference if this would allow safe administration of therapy. When choosing an appropriate site, consider for each patient:
- The condition of the patient’s skin and vasculature at the insertion site
- Any contraindication to choosing which limb, for example, axillary lymph node clearance, or presence of arteriovenous fistula
- How painful insertion might be for the patient
- Whether your expertise matches the complexity of the insertion procedure at the site so that the device can be inserted successfully on the first attempt; ultrasound may assist you to identify more appropriate sites.
Use a site that is likely to last the duration of the prescribed therapy to maximise dwell time and patient comfort. This means choosing a site that will promote self-care, prevent accidental removal or blockage, and facilitate the safe administration of therapy. Avoid areas of flexion unless clinically necessary; re-site cubital fossa IVs as soon as appropriate. Do not use veins in the lower extremities unless this is necessary; for example, because of a risk of tissue damage and local site complications in the upper extremities.
Choose the right peripheral device (length and gauge) by considering the type of therapy the patient needs, including whether the PIVC is to be used to administer contrast media for diagnostic purposes, and the duration of treatment. Use devices with safety-engineered protective features to reduce the risk of injury involving a sharp.