Choose the right insertion site and PIVC

Quality statement 4

A patient requiring a PIVC is assessed to identify the most suitable insertion site and PIVC (length and gauge) to meet their clinical needs and preferences for its location.

Purpose

To ensure that an appropriate PIVC is selected and inserted in a suitable site that minimises the risk of failure and other PIVC-related complications, taking into account the patient’s clinical condition and preferences for the location of the PIVC.

What the quality statement means

For patients

Your clinician will assess you to see where your PIVC should be placed, considering:

  • Your preferences for its location and whether therapy can be delivered safely there
  • The condition of your veins and skin
  • How much you can move
  • Whether it will be painful
  • How likely it is that they will be able to insert it on the first attempt.

If possible, your PIVC will be placed in the arm that you use the least and locations where problems are more likely to develop will be avoided.

For clinicians

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.

For health service organisations

Ensure that policies describe the criteria for selection of PIVC insertion sites and types of devices.

Ensure that clinicians involved in choosing insertion sites are adequately trained, and know how to select the most appropriate PIVC and insertion site for the patient’s intended therapy. This includes knowing the:

  • Patient’s clinical condition
  • Insertion technique for the specific device
  • Potential for complications
  • Appropriateness of the device for the prescribed therapy.

Ensure devices with safety-engineered protective features are available at the point of care to reduce the risk of injury involving a sharp. Examples include devices such as needles with guards, sliding sheaths, shields, blunted tips or retracting needles.

For patients

Your clinician will assess you to see where your PIVC should be placed, considering:

  • Your preferences for its location and whether therapy can be delivered safely there
  • The condition of your veins and skin
  • How much you can move
  • Whether it will be painful
  • How likely it is that they will be able to insert it on the first attempt.

If possible, your PIVC will be placed in the arm that you use the least and locations where problems are more likely to develop will be avoided.

For clinicians

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.

For health service organisations

Ensure that policies describe the criteria for selection of PIVC insertion sites and types of devices.

Ensure that clinicians involved in choosing insertion sites are adequately trained, and know how to select the most appropriate PIVC and insertion site for the patient’s intended therapy. This includes knowing the:

  • Patient’s clinical condition
  • Insertion technique for the specific device
  • Potential for complications
  • Appropriateness of the device for the prescribed therapy.

Ensure devices with safety-engineered protective features are available at the point of care to reduce the risk of injury involving a sharp. Examples include devices such as needles with guards, sliding sheaths, shields, blunted tips or retracting needles.

Read quality statement 5 - Maximise first insertion success