Common Anatomic Sites of Peripheral Vein for Cannulation

Common Anatomic Sites of Peripheral Vein for Cannulation

Choosing Intravenous Sites

A good vein is bouncy, soft, refills when depressed, visible, has a large lumen, well supported by surrounding tissues and straight. Many sites can be used for IV therapy, but ease of access and potential hazards vary. Veins of the extremities are designated as peripheral locations and are relatively safe and easy to enter, arm veins are most commonly used. The metacarpal, cephalic, basilic, and median veins as well as their branches are recommended sites because of their size and ease of access. More distal sites should be used first, with more proximal sites used subsequently. Avoid veins which are thrombosed / sclerosed, inflamed / bruised, hard, thin / fragile, mobile/tortuous, near bony prominences, painful, areas or sites of infection, edema or phlebitis. The arm on the side of a mastectomy is avoided because of impaired lymphatic flow. In addition to the arm veins, scalp vein can be used in infants and small children. Leg veins should rarely be used (if other site is unavailable) because of the high risk of thromboembolism.

Central veins commonly used by physicians include the subclavian and internal and external jugular veins. It is possible to gain access to or cannulate these larger vessels even when peripheral sites have collapsed. Hazards are much greater, however, and may include inadvertent entry into an artery or the pleural space. Ideally, both arms and hands are carefully inspected before choosing a specific venipuncture site that does not interfere with mobility.

The Forearm Veins

Cephalic Vein

Forms from a confluence of veins at the base of the thumb and passes upward along the radial (lateral) aspect of the forearm to enter the lateral part of the antecubital fossa (the triangular area on the anterior view of the elbow). Readily receives a large cannula and is therefore a good site for blood administration.

The basilic Vein: Forms from a confluence of veins on the postero-medial aspect of the wrist and passes upward slightly posterior to the ulnar (medial) border of the forearm but winds round over the ulnar to enter the medial aspect of the antecubital fossa.

Metacarpal vein: Easy to see and palpate veins but flow may be affected by wrist flexion and extension.

The Veins of Antecubital Fossa

Large veins and so they will readily accept a large cannula. First choice in emergency situation but the flow rate may be positional from extension and flexion of the elbow

  • Cephalic Vein: A continuation of the vein upward from the antero-lateral aspect of the forearm onto the antero-lateral aspect of the arm over the biceps muscle. From here it passes up to the deltoid muscle.
  • Basilic Vein: A continuation of the vein from the antero-medial aspect of the forearm. It may pierce the superficial fascia in the antecubital fossa and join the deep veins to form the brachial vein or it may traverse the antecubital fossa and pierce the fascia at a variable point on the medial aspect of the arm.
  • Median Vein: There may be more than one median vein in the antecubital fossa.

Table 8.1 Factors to Consider When Selecting a Site for Venipuncture

  • Condition of the vein
  • Type of fluid or medication to be infused
  • Duration of therapy
  • Patient's age and size: For infants, veins in the scalp may be used; for adults, veins in the arms are commonly used.
  • Whether the patient is right- or left-handed
  • Patient's medical history and current health status
  • Skill of the person performing the venipuncture

Figure 8.1 The for arm veins
Last modified: Wednesday, 16 November 2016, 5:13 PM