How can palpation of the liver assist in identifying intravenous (IV) access sites?

From the Guidelines

Pressing on the liver can help identify IV sites by using a technique called the hepatojugular reflux test, which involves applying firm pressure to the right upper quadrant of the abdomen for about 10 seconds while observing the neck veins. This maneuver can help locate difficult-to-find veins for IV access by temporarily increasing central venous pressure and making the jugular and peripheral veins more visible and palpable. The technique is especially useful in patients with difficult venous access due to dehydration, obesity, or collapsed veins. Some key points to consider when using this technique include:

• Applying firm pressure to the right upper quadrant of the abdomen for about 10 seconds
• Observing the neck veins, particularly the external jugular veins, for distention
• Using the technique to locate difficult-to-find veins for IV access
• Being aware of the potential benefits and limitations of the technique, as discussed in studies such as 1 and 1. It is also important to note that the hepatojugular reflux technique is simple to perform and requires no special equipment, making it a valuable skill for healthcare providers who frequently place IVs in challenging situations, as highlighted in studies such as 1 and 1.

From the Research

Palpation of the Liver and IV Access Sites

• Palpation of the liver is not directly related to identifying intravenous (IV) access sites, as the liver is an organ located in the abdominal cavity and is not typically used as a landmark for IV access.
• However, ultrasound guidance, which can be used to visualize the liver and other internal structures, can assist in identifying IV access sites, particularly in patients with difficult venous access 2, 3, 4, 5.
• The use of ultrasound guidance for peripheral intravenous access has been shown to have a high success rate and can reduce the need for central venous catheters 3, 5.
• Ultrasound-guided central venous access has also been shown to decrease the number of needle puncture attempts, complications, and failure rates 2, 4.

Ultrasound Guidance for IV Access

• Ultrasound guidance can be used to evaluate anatomical variations and absence of vascular thrombosis during preprocedural site selection 2.
• Real-time ultrasound guidance can be used to visualize the needle tip and guidewire in the target vein prior to vessel dilatation 2.
• The use of ultrasound guidance for IV access can reduce the risk of mechanical and infectious complications, particularly in patients with difficult venous access 2, 3, 4, 5.

Clinical Recommendations

• The Society of Hospital Medicine recommends the use of real-time ultrasound guidance for central venous catheter insertion, regardless of the provider's level of experience 2.
• The use of ultrasound guidance for peripheral intravenous access is recommended for patients with difficult venous access 3, 5.
• Competency assessments should include formal evaluation of knowledge and technical skills using standardized assessment tools, including proficiency in ultrasound-guided IV access 2.