I’ve been starting IVs for years, and my buddy and I probably started about 1000 IVs in 2016. At this point, I can pretty much walk into a room and immediately know where to look for veins. Where, you ask? Time for an anatomy lesson!
Forearms are usually the best places for an IV. The patient can’t bend anything without breaking something first, so your IV pump will love you.
Here are a few usual vein hiding spots:
- With a supine hand, look for the ventral forearm veins below the AC (the veins that form into the AC veins)
- With a prone hand, you might find a dorsal forearm vein that runs right along the top of the forearm
- Have the patient hang their arm over the side of the bed with their palm facing mostly backward (neutral position). Check around the back of the forearm and you can usually find a huge diagonal vein. It seems to be more common in men than women. This elusive vein is also notorious for valves so be careful!
The most common wrist vein is the radial vein that runs along the radial bone down from the thumb. Have the patient place their thumb upwards and trace along the thumb into the wrist/forearm region and you should find it usually going a diagonal direction over the bone. Watch out though because this vein is an infamous roller, and it’s right over top of a bone… ouch!
You may or may not find a vein going where most people would have a watch face (or their ID band) so give it a gander.
The other wrist veins are the ones that are just proximal to a supine palm. I’d consider these to be last resort veins because they’re super tiny and they hurt like hell. A lot of nerves and arteries run around in here, so be really careful and don’t go deep!
The Antecubital (AC)
Also known as the ER’s favorite vein haha. Seriously though, everyone’s got at least one good AC vein. Now the ER loves to go for it, but you should probably avoid it if you are on the floor and will have fluids running or you’ll suffer through so many alarms, you’ll hear beeps in your dreams. It’s also a place that the patient will end up bending a lot, so it’s inconvenient for them as well as you.
But sometimes you need one (for CT scans with contrast and other procedures), and other times, that’s the only vein you’ve got… so know that you can find a vein there. In fact, there are usually about 4 veins in the AC region. One on the inside, one on the outside (which typically runs upwards along the bicep) and two in the middle both going opposite directions on a slight diagonal (one inward and one outward).
Another area I like to avoid if I can. People have to wash their hands and that’s gonna wreak havoc on your Tegaderm. It also hurts like a b*tch getting an IV in the hand and these veins can be really fragile, especially in the elderly.
If you need a vein here, look along the metacarpus because the veins typically follow along those bones.
Getting desperate, are we? I’ve done my fair share of index finger veins when I’ve had no other choice. Just grab a 22 and look along the knuckle of the index finger on the side where it meets the thumb.
I once got an IV on some guy’s middle finger. But the patient was a huge PITA and it was more for the lolz.
Thumbs also sometimes have a vein, but the best luck I’ve had with fingers is that trusty index finger knuckle vein.
Going above the AC limits your abilities to use tourniquets but if you’ve read my other articles, I kinda hate them anyway. Check along the inside and outside of the bicep muscle for where the AC veins run upwards. These veins are probably going to be pretty deep. If you have a US machine you can find them no problem, but you might only see them on leaner male patients if you don’t have an ultrasound.
Most people have a couple shoulder options. You won’t be able to use a tourniquet for these either but the good news is they’re usually very shallow veins so you should be able to see them pretty clearly. Make sure to aim really shallow so you don’t go through and blow them. Not only are they typically really tiny, but remember since you can’t put a tourniquet on and inflate the vein, you have even less total vein height to get your bevel in without piercing the bottom.
Feet & Ankles
This may or may not be legal in your hospital or department, but if you can’t get a vein anywhere else, check the feet and ankles