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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., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

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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