What area should be avoided when selecting a PIV access site?

The wrist is a site that should be avoided when selecting a peripheral intravenous (PIV) access site due to several anatomical and functional considerations. The wrist is home to a complex arrangement of tendons, nerves, and arteries, making it a less than ideal location for venous access. In particular, the presence of the radial and ulnar arteries, along with several important nerves, increases the risk of complications such as hematoma, nerve injury, or arterial puncture.

Additionally, veins in the wrist area may not be as stable or prominent compared to sites in the forearm or upper arm, leading to difficulties in successful cannulation. The motion of the wrist also makes it more likely that the cannulated vein will be irritated or dislodged, causing potential discomfort for the patient and complications that could lead to treatment delays.

In contrast, the forearm provides more accessible and stable veins. The upper arm may also be suitable for PIV access, although it can be more challenging in some cases. The lower leg is typically avoided for PIV access in adults due to increased risk of complications from mobility factors and the potential for deeper vein thrombosis. Therefore, given these factors, the wrist is the least favorable choice for PIV access.