Do you administer fluids through an artery or a vein (intravenous)?

Fluids Should Be Administered Through Veins, Not Arteries

Fluids should always be administered through veins (intravenous route) and never through arteries. 1 Intravenous (IV) administration is the standard practice for fluid resuscitation and medication delivery in clinical settings.

Rationale for Venous Administration

Anatomical and Physiological Considerations

• Veins have thinner walls and lower pressure than arteries, making them more suitable for fluid infusion
• Arterial administration can cause:
  • Severe tissue damage and necrosis
  • Thrombosis and embolism
  • Potential limb loss due to compromised circulation
  • Extreme pain due to high pressure and vessel sensitivity

Types of Venous Access

1. Peripheral Venous Access

   • First-line approach for most fluid administration 2
   • Acceptable during resuscitation if placed rapidly 2
   • Advantages:
     • Quick to establish
     • Lower complication risk than central access
     • Suitable for most isotonic fluids and medications
   • Limitations:
     • Not appropriate for solutions with osmolarity >850 mOsm/L 2
     • Not suitable for long-term parenteral nutrition (>2 weeks) 2
     • May cause thrombophlebitis with irritant solutions

2. Central Venous Access

   • Used when peripheral access is inadequate or for specific indications
   • Advantages:
     • Allows administration of hyperosmolar solutions (>850 mOsm/L) 2
     • Suitable for long-term therapy
     • Better for certain medications that need central delivery
   • Disadvantages:
     • Requires more training and time to place 2
     • Higher risk of complications (pneumothorax, infection)
     • Not recommended as initial vascular access in emergencies 2
     • Central catheters have increased resistance due to length, making rapid fluid boluses more difficult 2, 1

3. Intraosseous (IO) Access

   • Alternative when IV access cannot be established
   • Rapid, safe, and effective route for emergency vascular access 2
   • All IV medications can be administered via IO route 2
   • Particularly useful in pediatric resuscitation 2

Special Considerations

Fluid Selection and Administration

• Lactated Ringer's and other isotonic crystalloids are administered intravenously 3
• Solutions containing calcium (like Lactated Ringer's) should not be administered simultaneously through the same line as blood due to risk of coagulation 3

Alternative Routes in Special Circumstances

• Subcutaneous Route (Hypodermoclysis):
  • Can be used for mild to moderate dehydration in geriatric patients 2
  • Limited to isotonic fluids and volumes <3000 mL/day 2
  • Not suitable for emergency situations or when strict fluid balance is required 2

Parenteral Nutrition Considerations

• Peripheral PN should only be used when osmolarity doesn't exceed 850 mOsm/L 2
• Central venous access is needed for most parenteral nutrition patients 2
• Peripheral PN should be limited to anticipated duration of no more than 10-14 days 2

Pitfalls to Avoid

• Never administer fluids or medications into an artery
• Avoid using the femoral vein for parenteral nutrition due to high risk of contamination and thrombosis 2
• Don't use peripheral veins for hyperosmolar solutions (>850 mOsm/L) 2
• Avoid excessive fluid administration which can lead to fluid overload, pulmonary edema, and dilution of serum electrolytes 3

In emergency situations, establishing peripheral IV access should be the priority, with IO access as a backup if venous access cannot be quickly established. Central venous access, while valuable for specific indications, is not recommended as the initial approach for emergency fluid administration due to the time required for placement.