Peripheral venous cannulation, among the most common medical procedures, has revolutionized the practice of medicine. Peripheral intravenous (IV) catheters allow for the safe infusion of medications, hydration fluids, blood products, and nutritional supplements.
This topic will discuss the indications, contraindications, performance, and complications of peripheral venous catheter placement without the use of ultrasound guidance. Emergency vascular access in children, peripheral venous catheter placement under ultrasound guidance, and central venous catheter placement are reviewed separately. (See "Vascular (venous) access for pediatric resuscitation and other pediatric emergencies" and "Principles of ultrasound-guided venous access" and "Overview of central venous access".)
INDICATIONS, CONTRAINDICATIONS, AND DIFFICULTY
Indications for venous access — Most often, intravenous (IV) access is obtained to provide therapies that cannot be administered or are less effective if given by alternative routes. As examples, IV hydration and nutritional support can be given to a patient with severe vomiting or abdominal pain from a surgical condition. Certain medications are more effective when given intravenously due to rapid onset or increased bioavailability. Some clinical situations, such as cardiac arrest, require treatment using IV medications; blood products must be given intravenously. In some instances, IV catheters are left in place when medications are given intermittently over a longer period (eg, long-term antibiotic therapy) or in case of a potential emergency.
Indications for peripheral versus central venous access — The decision to obtain peripheral rather than central venous access depends upon clinical circumstances. In general, peripheral catheters are preferred when IV access is required for shorter periods, when direct access to the central circulation is unnecessary, and when smaller gauge catheters suffice. Peripheral access is generally safer, easier to obtain, and less painful than central access. In patients taking anticoagulants, peripheral access allows for direct compression of puncture sites and fewer hematoma-related complications compared with the sites used for central venous catheters.
Central venous catheters are often preferred in patients receiving sclerosing medications that can damage peripheral veins or being treated with vasopressors, which can cause injury if extravasated. Central venous access may also be preferable in patients with severe volume depletion or in whom peripheral venous catheter placement has a low likelihood of success (ie, frequent users of illicit IV drugs). (See "Placement of femoral venous catheters", section on 'Indications' and "Overview of central venous access", section on 'Indications'.)