I.V. ROUNDS: Selecting the best I.V. site for an obese patient

November 2004 
Volume 34  Number 11
Pages 14 - 14
  PDF Version Available!



    YOU MAY HAVE TROUBLE visualizing and palpating a vein suitable for I.V. cannulation in an obese patient because of overlying tissue, development of collateral circulation, and disease states exacerbated by obesity. These tips for easier I.V. starts in an obese patient may also help in patients with peripheral edema.

    * Warmth encourages vasodilation . Apply warm compresses to the site for 10 to 15 minutes before you attempt venipuncture.

    * Displace edema and extra tissue . You may need an assistant to help hold extra or edematous tissue out of the way while you insert an I.V. cannula. Because adipose tissue may be compressible, hold firm finger pressure over a spot where you're likely to find a vein and see if you can see or feel one in the depression. Before prepping, make an indentation on the skin with finger pressure, mark the spot using a sterile marker, or have your prepping solution and cannula ready to use quickly.

    * Use anatomic landmarks . Most patients have a superficial vein on the thumb side of the wrist. In patients who wear a wristwatch, which has a mild tourniquet effect, you may see a vein in the indentation left by the watchband. But because of the risk of nerve injuries and extremely painful venipuncture, use this area only in an emergency when no other veins are available.

    * Use multiple tourniquets . To distend veins, progress distally from the most proximal joint toward the site.

    * Shed some light on the subject . Use a transilluminator designed to show a vein's size and location. These devices feature disposable, sterile covers to minimize the risk of contaminating a prepped site; they can also help stabilize the vein in obese or edematous patients. Sometimes transillumination with a vein transilluminator (or a flashlight or otoscope, in a pinch) can show veins obscured by edema. When using these devices, be careful not to contaminate a prepped ...

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