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Fluids & Electrolytes
VENIPUNCTURE SITES in the hand and arm offer various advantages and disadvantages for children and adults. Let's look at some of the major benefits and drawbacks of common sites.
Formed by the union of the small digital veins of the fingers, the dorsal venous network lies on the back of the hand (see illustration at right).
* Advantages. The most distal veins in the upper extremity, these veins are easily accessed, visualized, and palpated.
* Disadvantages. These veins are smaller than those in the forearm, and using one of them limits the patient's use of his hand. You'll need to stabilize the catheter with an arm board. Because the hand has many nerve endings, venipuncture at this site can be painful.
Rising from the dorsal veins, the cephalic vein is on the lateral aspect of the wrist, proximal to the thumb.
* Advantages. A large vein, the cephalic is excellent for venipuncture and readily accepts large-gauge needles. In general, a cannula inserted at this site doesn't impair mobility or require an arm board in an older child or adult.
* Disadvantage. Because of joint motion, venipuncture sites in the wrist or antecubital fossa are at increased risk for complications.
This vein runs along the lateral aspect of the arm into the antecubital fossa. A network of veins on the lateral forearm may form the accessory cephalic, joining the cephalic vein at or above the antecubital fossa.
* Advantages. The accessory cephalic, a medium-sized to large vein, is excellent for venipuncture because it's easy to stabilize and palpate and it readily accepts large-gauge needles. This site can also be used without impairing patient mobility.
* Disadvantages. Valves at the junction with the cephalic vein may prohibit you from advancing the cannula. Also, the vein may be too short or difficult to locate in children.
Rising from the superficial palmar veins, the median vein runs along the ulnar aspect of the forearm.
* Advantages. This medium-sized vein is easy to access and stabilize.
* Disadvantages. Usually located between two branches of the median nerve, this vein may be difficult to palpate or visualize. Venipuncture in this area can be extremely painful, so avoid this site.
The basilic vein is located on the posterior-medial aspect of the forearm.
* Advantage. This large vein is easily palpated.
* Disadvantages. You may have trouble accessing this vein because of its location, and the patient must be positioned awkwardly during venipuncture.
These are found in the antecubital fossa: the median cephalic on the radial aspect, the median basilic on the ulnar aspect, and the medial cubital connecting the basilic vein to the cephalic vein at the elbow.
* Advantages. These large veins are easily accessible and often are visible or palpable in children when other veins aren't. In all patients, these veins may be used in an emergency.
* Disadvantages. Veins may be small and fibrosed if frequently used for venipuncture. Also, the antecubital area is difficult to stabilize and limits patient mobility, so it isn't recommended for ongoing therapy.
Source: I.V. Therapy Made Incredibly Easy!!, 3rd edition, Lippincott Williams & Wilkins, 2006.
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