IV Location for Anesthesia

Intravenous (IV) access is a fundamental component of modern anesthesia practice, providing a critical route for the administration of anesthetic agents, fluids, and medications ¹. The selection of an IV location for anesthesia significantly impacts the efficacy, safety, and comfort of the procedure. Proper IV placement is crucial for effective anesthetic delivery, minimizing complications, and ensuring optimal patient outcomes.

When choosing a location for IV access for anesthesia, several factors must be considered. These include the patient’s anatomy, the type and duration of the surgical procedure, the need for rapid drug administration, and the risk of complications such as infection or thrombophlebit

First, the patient’s age, size, and condition can influence the choice of IV site. In adults, peripheral veins in the hands and forearms are commonly used, while in children, other sites, such as veins in the lower extremities, might be considered more often. In patients with difficult venous access due to obesity, chronic illness, or previous IV drug use, alternative sites may need to be explored. Second, the type and duration of surgery should be considered. For short, less invasive procedures, a peripheral IV line is usually sufficient. However, for longer or more complex surgeries, a larger bore IV or central venous access might be necessary to ensure rapid administration of fluids and medications. Finally, the risk of complications such as infiltration, infection, and thrombophlebitis should be minimized by selecting an appropriate IV location and ensuring proper aseptic technique throughout anesthesia administration ^2,3.

For peripheral IV sites, the hands and forearms are the most common sites due to their accessibility and ease of insertion. The cephalic, basilic, and median cubital veins are frequently used, though complications are possible and should be taken into consideration ^4,5. The median cubital vein, located in the antecubital fossa, is also often selected for its size and ease of cannulation; however, it may restrict arm movement and is generally avoided for longer periods of access ⁶.

For central IV sites, the internal jugular and subclavian veins are preferred in situations requiring large bore access or when peripheral access is inadequate. These sites are used for major surgeries, critically ill patients, and those needing long-term IV therapy. The femoral vein is another option for central access, particularly in emergency situations, but it carries a higher risk of infection and thrombosis compared to other central sites ^7–9.

Regarding alternative IV sites in neonates and infants, scalp veins provide an accessible and reliable option for IV placement. In addition, veins in the lower extremities, such as the saphenous vein, may be used when upper extremity access is not feasible ^10,11

The efficacy of anesthesia administration is impacted by the reliability of IV access, making IV location an important clinical decision. Poorly chosen sites can lead to infiltration, delayed drug delivery, and inadequate anesthesia. In addition, proper IV placement reduces the risk of complications such as infection, thrombophlebitis, and mechanical issues like dislodgement. It also enhances patient comfort by minimizing the need for repeated attempts at cannulation. Finally, effective IV access facilitates the smooth administration of anesthesia and necessary medications during surgery, contributing to better surgical outcomes and faster recovery. It also ensures that emergency medications can be administered promptly if needed ^12–15.

References:

1. Intravenous Cannulation: Background, Indications, Contraindications. Available at: https://emedicine.medscape.com/article/1998177-overview.
2. Beecham, G. B. & Tackling, G. Peripheral Line Placement. StatPearls (2023).
3. Practice Guidelines for Central Venous Access 2020. Anesthesiology (2020). doi:10.1097/aln.0000000000002864
4. Kagel, E. M. & Rayan, G. M. Intravenous Catheter Complications in the Hand and Forearm. in Journal of Trauma – Injury, Infection and Critical Care (2004). doi:10.1097/01.TA.0000058126.72962.74
5. Peripheral IV — Peripheral Intravenous Catheter (PIVC). Available at: https://my.clevelandclinic.org/health/treatments/24930-peripheral-iv.
6. Median Cubital Vein: Anatomy, Function, and Significance. Available at: https://www.verywellhealth.com/median-cubital-vein-5118185.
7. Castro, D., Lee, L. M. M. & Bhutta, B. S. Femoral Vein Central Venous Access. StatPearls (2023).
8. Deere, M., Singh, A. & Burns, B. Central Venous Access of the Subclavian Vein. Code Blue 86–94 (2023). doi:10.1201/b17209-20
9. Mendenhall, B. R., Wilson, C., Singh, K., Dua, A. & O’Rourke, M. C. Internal Jugular Vein Central Venous Access. StatPearls (2023).
10. Cho, C., Koser, B. W. & Das, J. M. Scalp Vein Catheterization. StatPearls (2024).
11. Lee, M. M., Anand, S. & Loyd, J. W. Saphenous Vein Cutdown. StatPearls (2023).
12. Morrell, E. Reducing Risks and Improving Vascular Access Outcomes. J. Infus. Nurs. (2020). doi:10.1097/NAN.0000000000000377
13. Thomsen, S. L., Boa, R., Vinter-Jensen, L. & Rasmussen, B. S. Safety and Efficacy of Midline vs Peripherally Inserted Central Catheters among Adults Receiving IV Therapy: A Randomized Clinical Trial. JAMA Netw. Open (2024). doi:10.1001/jamanetworkopen.2023.55716
14. Haeseler, G., Hildebrand, M. & Fritscher, J. Efficacy and ease of use of an intravenous catheter designed to prevent blood leakage: A prospective observational trial. J. Vasc. Access (2015). doi:10.5301/jva.5000334
15. Peripheral venous access in adults – UpToDate. Available at: https://www.uptodate.com/contents/peripheral-venous-access-in-adults.