Chapter 27 ■ Peripheral Intravenous Line Placement 149

12. Place 5-0 silk suture loosely around vein and clamp at

end of suture with hemostat to allow for distal control

of vessel (Fig. 27.12). (Do not tie ligature.)

13. Place ligature with clamp across extended index finger

and inside palm of nondominant hand, retracting it in

an upward and caudad direction (Fig. 27.13).

14. Introduce cannula/stylet into vein at a 45-degree angle,

with bevel down. Once vein has been entered, angle

cannula parallel to vein (Fig. 27.14).

15. Advance cannula into vein while withdrawing inner

needle stylet.

16. Advance cannula up to hub, and infuse small volume

of saline flush solution to confirm IV position.

17. Remove traction suture and close skin incision with

subcuticular absorbable sutures or one or two simple

5-0 nylon sutures.

18. Attach cannula to infusion tubing and regulate IV.

19. Secure cannula to skin, as shown in Fig. 27.4.

F. Complications

1. Same as for percutaneous method

2. Inadvertent infusion of local anesthetic into artery or

vein

3. Severance of vein owing to excessively deep initial incision

4. Infiltration of IV infusion into body cavity (Fig. 27.15)

 This is a complication related to placement of very

long catheters. When infusion of an extremely irritating or hypertonic solution is required, the catheter is

preferably inserted into the central venous system (see

Chapter 32).

5. Varicose veins secondary to postinfusion phlebitis (26)

Conversion of Peripheral IV

Line to a Saline Lock

A. Technique

1. Wash hands and put on gloves.

2. Clean IV tubing and catheter connection with antiseptic solution.

3. Stop IV infusion and remove IV tubing from hub of IV

needle or cannula.

4. Seal hub with a sterile plug or T-connector system

(e.g., Argyle intermittent infusion plug [Consolidated

Medical Equipment, Utica, New York; Sherwood

Medical Co., St. Louis, Missouri] or Burron spin-lock

port extension set [Burron Medical, Bethlehem,

Pennsylvania] that has been primed with the required

Fig. 27.12. The hemostat has been carefully opened and the

subcutaneous connective tissue spread, leaving the vein surface

clean. A ligature is placed between the blades of the hemostat.

Fig. 27.13. Outward and caudad traction is exerted on the

suture.

Fig. 27.14. Introducing the cannula into the vein.