Peripheral intravenous (IV) catheter placement and phlebotomy are arguably the most commonly performed procedures in medicine, performed oon over 25 million patients each year in US hospitals. (Soifer 1998). This skill should be a part of the basic skill set of any health care provider. Phlebotomy is simply drawing blood. IV catheterization allows blood sampling as well as ongoing direct access into the circulating bloodstream. The fundamental techniques are the same. As commonplace as these procedures are, however, they are not entirely without complications, local and systemic.

How to use this chapter

Multimedia content

Contributors

Peripheral versus Central Access?

IV access can be obtained centrally (i.e internal jugular vein, subclavian vein, femoral vein) or peripherally. In the medically stable patient, peripheral access is preferred. Peripheral IVs are faster and easier to obtain, less traumatic, and have fewer and less severe complications than central lines. Peripheral needle sticks are also easily compressible, which is an additional advantage for patients requiring thrombolysis or who are coagulopathic. Due to the smaller caliber of the vessels and thin walls however, peripheral IV placement can be difficult in low-flow states such as dehydration. Furthermore, in critically-ill individuals, peripheral circulation may be slowed or shunted. Central venous access is preferred in these settings because they are larger bore, can have multiple port sites, and allow drug administration directly into the central circulation. Central venous access is discussed elsewhere in the MPM.