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IV Access Guide

Educational content covering indications, sites, flow rates, and complications for various intravenous access methods.

Peripheral IV (PIV)

Indications

  • Short-term IV therapy (< 7 days)
  • Routine hydration
  • Non-vesicant medications
  • Blood transfusions

Max Flow Rates / Capacity

  • 24G (Yellow): ~20 mL/min (Pediatrics/Fragile veins)
  • 22G (Blue): ~35 mL/min (Standard meds/fluids)
  • 20G (Pink): ~60 mL/min (Blood products, routine OR)
  • 18G (Green): ~100 mL/min (Trauma, rapid resuscitation)
  • 16G (Grey) / 14G (Orange): >150 mL/min (Massive transfusion/Trauma)

Site Selection

Start distally (hand/forearm) and move proximally. Avoid areas of flexion, bruised veins, or limbs with fistulas/mastectomies.

Complications

  • Phlebitis
  • Infiltration
  • Extravasation
  • Thrombosis

Central Venous Catheter (CVC)

Indications

  • Hemodynamic monitoring (CVP)
  • Vesicant medications (vasopressors, chemo)
  • TPN administration
  • Poor peripheral access
  • Long-term therapy (> 7 days)

Max Flow Rates / Capacity

  • Varies by lumen size, but generally supports high-volume, rapid resuscitation (especially large-bore single lumen like a Cordis).

Site Selection

Internal Jugular (IJ), Subclavian (SC), or Femoral vein.

Complications

  • CLABSI (Central Line-Associated Bloodstream Infection)
  • Pneumothorax (especially Subclavian)
  • Arterial puncture
  • Air embolism
  • Thrombosis

Peripherally Inserted Central Catheter (PICC)

Indications

  • Long-term IV therapy (weeks to months)
  • Antibiotic therapy
  • TPN
  • Chemotherapy

Max Flow Rates / Capacity

  • Not ideal for rapid large-volume resuscitation due to length and resistance (Poiseuille's law).

Site Selection

Inserted peripherally (usually basilic or cephalic vein in the upper arm) with the tip terminating in the superior vena cava (SVC).

Complications

  • DVT / Thrombosis
  • CLABSI
  • Catheter migration or occlusion

Intraosseous (IO) Access

Indications

  • Emergency resuscitation when peripheral access fails
  • Cardiac arrest
  • Severe trauma
  • Massive shock in pediatrics or adults

Max Flow Rates / Capacity

  • Comparable to a 16G or 14G peripheral IV. Rapid fluid administration requires a pressure bag.

Site Selection

Proximal tibia (most common), distal femur, proximal humerus, sternum.

Complications

  • Osteomyelitis
  • Compartment syndrome (if fluid extravasates)
  • Bone fracture
  • Pain (in conscious patients, infuse lidocaine first)