..…if patients offer their antecubital fossa to you for an IV start. Sad but true, many patients do not understand the difference between blood draw and starting a peripheral IV. We, as registered nurses should understand the difference and know that starting an IV in the antecubital fossa is not good practice.

The antecubital fossa is in front of the elbow, bounded laterally and medially by the humeral origins of the extensors and flexors of the forearm, respectively, and superiorly by an imaginary line connecting the humeral condyles. This area contains the anterior branches of the medial and lateral cutaneous nerves of the forearm and the median cubital vein, which joins the cephalic and basilic veins. The cephalic, basilic and median cubital veins are usually easily seen and palpated in the roof of the fossa, and this is therefore a common site for blood draw. The use of the cubital fossa for intravenous fluid therapy is not recommended because movement of the elbow joint disturbs the catheter and irritates the vein wall with the consequence that thrombosis of the vein quickly occurs. The brachial artery is palpated here when the arterial pressure is being taken using a sphygmomanometer but, because of the bicipital aponeurosis, the elbow should be fully extended so that the artery is pressed back on to the elbow joint to render palpation a little easier. The brachial artery is in close relation to the median nerve, which lies on its medial side. Awareness of this relationship should minimize the incidence of nerve trauma during puncture for blood sampling or the insertion of vascular catheters. (1)

The Infusion Nursing Standards of Practice states “site selection for peripheral short catheter should avoid areas of flexion” (S37H).(2) The antecubital fossa is an area of flexion and placement of a peripheral IV is uncomfortable for the patient due to the need to keep elbow extended in an unnatural position. In addition, the area is difficult to splint with the use of arm board. The use of the veins in the antecubital fossa should be reserved for blood collection, for the insertion of midline catheters and peripherally inserted central catheters. In the event of an emergency, if the antecubital vein is used, change the site within 24 hours or sooner.

So on a busy day at work, when you are looking for a vein to start a peripheral IV, RESIST the temptation to use the antecubital fossa. Explain to the reason to the patient and find a vein in the distal areas of the arm. Be patient and take the time to assess and palpate veins as some will not pop up like the median cubital veins. Oh, one last thing, if the patient insists on using the antecubital fossa, remember, unsuccessful attempts will limit the use of the veins below.

1. The cubital fossa: AnesthesiaUK at http://www.frca.co.uk/printfriendly.aspx?articleid=100363
2. Site Selection. Infusion Nursing Standards of Practice 2006. Infusion Nurses Society Norwood, MA.
3. Picture courtesy of: http://www.frca.co.uk/printfriendly.aspx?articleid=100363

4 thoughts on “JUST SAY NO….

  1. In the ER we have protocols to use the AC for many common emergent conditions (eg, probable cath lab patients or PE protocol patients). If we don’t have a large-bore IV in the AC, these ancillary services send the patient back. If those conditions don’t seem to apply, I do look around for other sites and explain to the patient that I’m “saving” the AC veins, but they often do get weirdly impatient about it. “Just use the one in my elbow and quit tying that tourniquet!” I enjoy your articles…keep ’em coming.

  2. Pingback: At a glance…IV tips for Janaury 2010 « Infusion Nurse's Blog

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