Complete Guide To Peripheral IV for ER Patients

peripheral iv
If a patient is unconscious, unable to swallow, or oral medications are slow to take effect, it can be difficult to administer medication. An intravenous (IV) injection or infusion is a commonly used solution in such cases. Through the IV injection, it’s possible to efficiently deliver fluids and medications to a patient’s body.

This is done by inserting a catheter into a vein in the hand, arm, elbow, or scalp to directly administer the treatment. The passageway allows healthcare professionals to repeatedly infuse medication without needing to poke the patient with a needle every time.

An ultrasound-guided peripheral IV placement procedure can be particularly helpful in guiding a venipuncture and catheter-over-needle into a nonpalpable, deep vein in the upper arm.

Let’s explore all there is to the peripheral IV or PIV procedure.

What Is a Peripheral IV?

A peripheral IV is also known as a peripheral IV catheter/line, or a peripheral venous catheter.

It is a small, short, flexible plastic catheter or plastic conduit that is injected into a vein, through the skin. It pierces the layers of skin and fat to reach the vein in the hand, elbow, or upper arm while allowing fluids, medications, blood transfusions, and other therapies to be directly introduced into the peripheral vein. 

With over a billion lines being used worldwide each year, this is the most commonly performed medical procedure.

The drugs that are typically given through IV include:

  • Chemotherapy drugs like vincristine, cisplatin, paclitaxel, and doxorubicin
  • Antifungal drugs like amphotericin and micafungin
  • Antibiotics like gentamicin, meropenem, and vancomycin
  • Pain relief medications like morphine and hydromorphone
  • Drugs to treat low blood pressure like dopamine, epinephrine, norepinephrine, and vasopressin
  • Immunologic medications

Nutritional supplements and blood transfusions may also be delivered through IV for patients who require them.

When Is a Peripheral IV Performed?

Peripheral IVs are performed in the following scenarios: 

  • To control the medication dose 
  • To administer emergency medication to patients who are unconscious or in an acutely ill condition. 

This is especially true for patients with difficult vascular access (DVA). Difficult vascular access is a potentially critical condition that can affect the efficiency of the medication delivered to an at-risk patient, thereby impacting the effectiveness of emergency medical care.

DVA can make it difficult to resuscitate unstable patients as healthcare providers may be unable to administer life-saving medications and fluids. 

In such instances, it is especially important to perform a peripheral IV. 

Other applications for a peripheral IV include if a patient is unconscious, acutely ill or generally requires highly precise doses of medications that work rapidly and cannot be delivered orally.

If the peripheral IV is inserted for a particular treatment or procedure, the placement should be performed as close to the procedure time as possible. This reduces the risk of the line being dislodged in the interim.

How Is a Peripheral IV Different From a Central Venous Catheter?

Central and peripheral venous catheters are tubes used to deliver fluids or drugs to a patient. They both require a trained medical professional to administer them. However, that is where their similarities end.

Central venous catheters enter the body through a major vein deep under the surface of the skin. This is the key difference between the two procedures as the central venous catheter is entered from the internal jugular vein in the neck, the subclavian vein in the upper chest, or the common femoral vein in the groin. Meanwhile, the peripheral IV site is usually on the hand or arm of the patient.

The tube for the central venous catheter is much longer compared to the peripheral IV’s tube, and it can be placed in the body for longer periods of time.

Central venous catheters are associated with more serious complications including bleeding, lung collapse, artery or vein damage, thrombosis, narrowing of veins, clotting, or embolism.

What Are the Benefits of a Peripheral IV?

Most healthcare providers, including first responders, receive training on how to insert a peripheral IV as it is the most common type of intravenous line. Once the IV is placed, it can remain in place for several days before it needs to be replaced.

The major advantages of peripheral IV include its ease of insertion and the fact that the equipment required to insert it is readily available to healthcare providers.

It is also extremely safe. First-time IV placements are successful in 65% to 85% of cases.

What Are the Risks Associated With Peripheral IV?

As effective as peripheral IV is, it also has certain risks:

  • Infection which can be accompanied by swelling, pain, fever, chills, redness, and discoloration at the peripheral IV site
  • Damage to the veins can cause inflammation, pain, swelling, and extreme warmth in the area
  • Air embolism caused by air bubbles entering the vein from the syringe or IV medication bag (this is dangerous to the lungs and heart)
  • Blood clots can cause severe damage to the tissues and can be potentially fatal in severe cases

In addition to these risks, peripheral IV can also be challenging among certain patients who have:

  • A history of difficult placement
  • Dehydration
  • Darker skin tones
  • Non-visible or small veins
  • History of illicit intravenous drug use
  • Health conditions like sickle cell disease and diabetes
  • Underweight or obesity
  • Scar tissue or previous injuries near the IV sites

Healthcare providers may also find it relatively more difficult when placing peripheral IVs in women and people who were assigned female at birth.

Final Thoughts

Delivering a peripheral IV is an important procedure. Knowing how it is performed is extremely crucial to be an effective and efficient healthcare provider.

If you’re looking to polish your skills and learn how to administer a peripheral IV with hands-on practice, our Ultrasound-guided Peripheral IV Course has all the information you need!

At Hospital Procedures Consultants, we are committed to helping you enhance and improve your knowledge and practical skills when it comes to hospitalist and emergency procedures.


Gorgone, M. O´Connor, T. Maximous, S. Ultrasound-guided Peripheral Venous Access. Journal List. 3(4); 2022.
Stolz, L. Stolz, U. Howe, C. Farrel, I. Adhikari, S. Ultrasound-guided peripheral venous access: a meta-analysis and systematic review. J Vasc Access. 2015 16(4):321-6
Beecham, G. Tackling, G. Peripheral Line Placement. Continuing Education Activity. 2022. 25(7)
Statter, MB . Peripheral and central venous access. Semin Pediatr Surg. 1992 ;1(3):181-7.
Gentges, J. Arthur, A. Stamile, T. Figureido, M. Peripheral Intravenous Line Placement and Utilization in an Academic Emergency Department. J Emerg Med. 2016 ;50(2):235-8. 

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