When assessing an extremity for a vein for IV access which is the appropriate technique for palpating a vein?

Open access peer-reviewed chapter

Submitted: February 9th, 2021 Reviewed: February 13th, 2021 Published: March 19th, 2021

DOI: 10.5772/intechopen.96613

Abstract

Difficult intravenous access [DIVA] may occur due to several factors, such as the demographic and clinical characteristics of the patients [age, sex, height, weight, ethnicity, IV drugs history, and medical history], health professional’s experience, device characteristics, site of insertion, and vein characteristics. Difficult intravenous access leads to repeated insertion attempts that might prove to be uncomfortable for the patients, frustrating and challenging for the health professionals, and expensive for the health institutions. The practitioners must develop the awareness of the factors capable of increasing the difficulty of defining the appropriate vein for cannulation through their varied experiences with vein location and vascular access.

Keywords

• difficult cannulation
• patient
• practitioner

• Handan Eren*

  • Department of Nursing, Yalova University, Yalova, Turkey

*Address all correspondence to:

1. Introduction

Difficult intravenous access [DIVA] is defined as a catheter insertion condition when the catheter cannot be entered into the vein in one attempt [1]. A published systematic review and meta-analyses reported a failure rate of up to 30% on the first attempt of peripheral intravenous cannulation [2]. Other research identifies a failure rate ranging from 10%–40%, which is consistent with the findings from a study by Witting [2012], who reported that 39% of first time attempts at peripheral intravenous cannulation [PIVC] failed [3, 4].

DIVA may occur due to several factors and lead to multiple repetitive attempts to gain peripheral venous access, which causes the patients to experience pain and anxiety and the healthcare professionals to feel inadequate [1]. In addition, as the number of materials used in the repetitive attempts increases and the treatment plan for the patient is delayed, the patient care costs also increase [5, 6]. Therefore, it is crucial for healthcare professionals to be aware of the factors that may lead to this condition, including several negativities, to understand how to manage it [7, 8]. The guidelines available for peripheral intravenous insertion mainly focus on site selection and insertion, and there is a lack of established guidelines on how to recognize or manage DIVA [1, 9, 10, 11]. In this context, the present study was aimed to provide basic information regarding the risk factors for difficult peripheral intravenous cannulation and its management.

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2. Individual factors

The individual risk factors associated with DIVA are age, gender, ethnicity, body mass index, health status, medical history, and vein characteristics of the patients [7, 12, 13, 14].

2.1 Age

The age of the individual might affect the intravenous catheter insertion. With increasing age, the vein diameter expands, thereby increasing the visibility and palpability of the veins [13, 15]. Therefore, it could be relatively difficult to determine the appropriate vein in neonates and children. According to the literature, the success rate of catheter insertion in the first attempt observed in the pediatric clinics varies between 44% and 86% [15, 16]. However, similar rates are observed in older ages. This might be because of the decreased elasticity of the blood vessels at an advanced age, which could contribute to DIVA. In the studies conducted by Van Loon et al. with 3586 participants and by Armenteros-Yeguas et al. [2017] with 135 participants, no relationship between the age of the individuals and DIVA was observed, although DIVA was observed to be related to the presence of chronic disease and medical treatment. The increased possibility of chronic diseases in advanced age would result in a medical treatment history, leading to DIVA [12, 13].

2.2 Gender

Studies have reported that gender is a risk factor for difficult venous access. Jacobson and Winslow [2005] reported that catheter insertion procedure is more difficult in women compared to men. This could be explained by the smaller caliber of peripheral veins in women [17]. Piredda et al. [2019] also reported gender as one of the risk factors for difficult venous access and that the procedure could be relatively difficult in women. In the same study, 99.4% of the women who underwent lymph node dissection experienced DIVA, suggesting an association; the multivariate analysis conducted in the study revealed that lymph node dissection did not exert a statistically significant effect on difficult cannulation [7].

2.3 Ethnicity

Individuals with different ethnicities may have different skin colors, and peripheral intravenous cannulation [PIVC] might be difficult in certain individuals of particular skin color. A narrative review published in 2010 by Sabri et al. reported an association between skin color and DIVA [18]. Jacobson and Winslow [2005] also reported that catheter insertion was more difficult in individuals with dark and/or tough skins [17].

2.4 Body mass index

Body mass index [BMI] is a measure of body fat based on the height and weight of the individual. An increase in weight may cause an increase in the adipose tissue and, therefore, a decrease in the visibility of the veins, rendering the catheter insertion difficult [14, 17]. Several studies have reported body mass index as a risk factor for difficult catheter insertion [7, 13, 14]. Sebbane et al. [2013] reported that underweight patients [BMI