What is a contraindication for peripheral intravenous (PIV) insertion?

The presence of a venous thrombus in the arm represents a contraindication for peripheral intravenous (PIV) insertion because it significantly increases the risk of further complications. When a thrombus is present, attempting to insert a PIV catheter can exacerbate the condition, potentially leading to a clot becoming dislodged, which could subsequently travel to the lungs (pulmonary embolism) or other critical areas, resulting in serious health risks. Inserting an IV in a limb with a thrombus also poses challenges in achieving effective venous access, may lead to pain for the patient, and could impede the flow of IV fluids or medications.

In situations with high osmolarity solutions, such as those exceeding 500 mOsm/L, careful consideration is required, but this does not constitute a strict contraindication; rather, the infusion may simply need to be administered through a central line to avoid complications. Non-irritant solutions are typically safe for PIV use and do not represent a contraindication. The administration of a single dose of a vesicant medication does require caution, and while it is generally suggested that these medications go through central lines or specific PIV sites to avoid tissue damage, it is not outright contraindicated. Therefore, while various