Intravenous (IV) placement is an important process in the administration of anesthesia, serving as the primary route for the delivery of fluids, some anesthetics, and other medications during surgical procedures. Ensuring effective and efficient IV placement is essential for patient safety and optimal anesthesia management. IV placement involves the insertion of a catheter into a peripheral vein, typically in the hand or arm, providing direct access to the bloodstream. While routine, this procedure requires skill and precision to minimize complications such as infiltration, phlebitis, or infection. The choice of vein is influenced by factors such as patient anatomy, type of surgery, and duration of anesthesia (1).

Proper IV placement begins with the selection of an appropriate site. The dorsum (back) of the hand and antecubital fossa (inside of the elbow) are common sites due to their accessibility and vein size. However, patient-specific considerations such as vein quality and patient comfort must be taken into account. The use of ultrasound guidance can improve the success rate of IV placement, especially in patients with difficult venous access, by providing real-time visualization of the veins and surrounding structures (1). Sterility is paramount in IV placement to prevent infection. The skin must be cleansed with an antiseptic solution, and the practitioner should wear sterile gloves. The use of a tourniquet can help distend the vein, making it more prominent and easier to cannulate. After the vein is identified and the skin is prepped, a needle is inserted at a shallow angle, and once blood return is observed, the catheter is advanced into the vein and secured in place. While rare, complications associated with IV placement can have significant consequences. Infiltration, where the IV fluid leaks into the surrounding tissue, can cause swelling and discomfort. Phlebitis, an inflammation of the vein, can occur due to mechanical irritation or infection. To reduce these risks, it is important to select the appropriate catheter size and ensure proper insertion technique (2).

In the context of anesthesia administration, the reliability of IV access is critical. Anesthetics administered intravenously can cause rapid changes in patient physiology that require immediate and precise control. In addition, the IV site should be monitored regularly for signs of complications, and alternative sites should be readily available in the event of IV failure (3). Advancements in IV placement techniques and technology have contributed to improved outcomes. The integration of ultrasound guidance, the development of more biocompatible catheter materials, and improved training programs for healthcare providers have combined to improve the safety and efficacy of IV placement for anesthesia (3). These innovations not only improve the success rate of the procedure, but also enhance patient comfort and reduce the incidence of complications.

In conclusion, IV placement is a fundamental aspect of anesthesia practice that requires careful attention to technique and patient-specific factors. The use of advanced technology and adherence to sterile protocols are essential to optimize procedural success and minimize complications. Continued research and education in IV placement will further improve patient outcomes and the overall safety of anesthesia.

References

1. Fields JM, Piela NE, Au AK, Ku BS. Risk factors associated with difficult venous access in adult ED patients. Am J Emerg Med. 2014;32(10):1179-1182. doi:10.1016/j.ajem.2014.07.008
2. Helm RE, Klausner JD, Klemperer JD, Flint LM, Huang E. Accepted but unacceptable: peripheral IV catheter failure. J Infus Nurs. 2015;38(3):189-203. doi:10.1097/NAN.0000000000000100
3. Stolz LA, Stolz U, Howe C, Farrell IJ, Adhikari S. Ultrasound-guided peripheral venous access: a meta-analysis and systematic review. J Vasc Access. 2015;16(4):321-326. doi:10.5301/jva.5000346