From the Guidelines
Palpation of the liver is not a recommended technique for locating intravenous (IV) access sites, as the current evidence supports the use of ultrasound guidance for improving success rates and reducing complications in patients with difficult venous access. When considering methods to improve IV access, several techniques can be employed, including:
- Applying warm compresses to increase blood flow
- Using a tourniquet to occlude venous return
- Having the patient open and close their fist to increase venous distension
- Tapping gently over potential venipuncture sites to help identify veins However, ultrasound guidance is the preferred method for locating IV access sites, particularly in patients with difficult venous access, as it has been shown to improve success rates and reduce complications 1. The use of ultrasound guidance for IV placement has been studied in various patient populations, including those with obesity, drug abusers, and infants, and has been found to be effective in improving success rates and reducing the number of attempts and time to cannulation 1. In addition, ultrasound guidance has been shown to be beneficial for arterial cannulation, particularly for radial artery catheterization, as it improves time to catheterization and reduces the number of attempts 1. Overall, while various techniques can be used to improve IV access, ultrasound guidance is the recommended method for locating IV access sites, particularly in patients with difficult venous access, due to its ability to improve success rates and reduce complications.
From the Research
Palpation of the Liver and IV Access Sites
- The question of whether palpation of the liver can assist in locating intravenous (IV) access sites is not directly addressed in the provided studies 2, 3, 4, 5, 6.
- However, the studies do discuss the importance of vein location and assessment in improving the success rates for vascular access 3, 5, 6.
- Vein palpation is mentioned as a technique used to locate veins, particularly in difficult cases 3, 5, 6.
- The use of vessel locating devices, such as those using light, sound, or tactile actions, is also discussed as a potential aid in locating veins 3, 6.
- However, the study by 6 found that novice clinicians did not choose more veins for optimum catheter placement when assisted with vessel locating devices compared to palpation techniques.
- There is no direct evidence to suggest that palpation of the liver is a useful technique for locating IV access sites.
Vein Location and Assessment
- The studies emphasize the importance of vessel health and preservation, and vein palpation, in improving the success rates for vascular access 3, 5.
- The choice of insertion site for an intravenous catheter is a known predictor of catheter failure 6.
- Careful consideration of the selected site of insertion could modify this risk factor for catheter failure 6.
- The use of ultrasound-guided peripheral IV access is discussed as a potential solution to improve the success rates for vascular access, particularly in difficult cases 2, 4, 5.