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Avoiding wrist area for PIV insertion

At our institution we start PIVs 2-3 finger widths from the wrist--and higher due tothe risk of  nerve damage, carpal tunnel issues, etc.  Does anyone have a quick reference to support this?


Thank you in advance! 

Yes, the following is a

Yes, the following is a French study of anatomical dissection of cadavers. The found that the sensory branch of the median nerve can intersect with the cephalic vein up to 3 times near the wrist.

Vialle, R., C. Pietin-Vialle, P. Cronier, C. Brillu, F. Villapadierna, and P. Mercier, 2001, Anatomic relations between the cephalic vein and the sensory branches of the radial nerve: How can nerve lesions during vein puncture be prevented?: Anesthesia and Analgesia, v. 93, p. 1058-61. 

The following is a report of serious complications occuring in the hand and wrist:

Kagel, E., and G. Rayan, 2004, Intravenous catheter complications in the hand and forearm: Journal of Trauma, v. 56, p. 123-27.

Hope these help

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Unintentional arterial

Unintentional arterial puncture during cephalic vein cannulation:

case report and anatomical study²

P. Lirk1 3 *, C. Keller1, J. Colvin1, H. Colvin3, J. Rieder1, H. Maurer2 and B. Moriggl2

1Department of Anesthesiology and Critical Care Medicine and 2Institute of Anatomy, Histology & Embryology, Medical University of Innsbruck, Austria. 3Department of Anesthesiology, Medical College of

Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA

*Corresponding author at Medical College of Wisconsin. E-mail: [email protected].


Intravenous Therapy Malpractice, Chapter 27 of "Nursing Malpractice", 3rd edition, January 2007 - Sue Masoorli's excellent contribution to this extremely useful text. 

I know Nancy Moreau has covered this as well - don't have any articles immediately at hand.


Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

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