Under practice criteria I A it talks about site selection. When it says avoid the lateral surface of the wrist for approx. 4 or 5 inches, that seems kind of long to me. So, I thought I should ask , is the 4 to 5 inches only above the wrist (up the arm more) or does it encompass above and below the wrist?
Thank you!
This is based on information about nerve damage. Cadaver studies have shown that the sensory branch of the radial nerve can intersect with the cephalic vein up to 3 times in the area beginning at the origin of the cephalic vein directly at the wrist above the thumb and extending for the stated distance up the arm. So this begins at the origin of the cephalic vein and moves up the arm. Direct puncture can transect the nerve causing neuroma and/or producing complex regional pain syndrome. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you.
Kathleen Wilson, CRNI
I want to bring up this practice issue at my facility, but want to be clear about the origin of the Cephalic.
I spoke to some local resources and looked in my info, but still need to ask: It the origin at the wrist, or distal to it? Would you start counting your 4 to 5 inches at the wrist, or below it? Does the Accessory Cephalic run to the beginning of the Cephalic?
Since my awareness of Standard 33, I have been more aware, and seen lots of IVs placed in this area. Also, I am finding that many people think the Cephalic is only in the upper arm.
Kathleen Wilson, CRNI
This is taken from Gray's Anatomy and is quoted directly:
"The cephalic vein originates over the anatomical snuff box at the base of the thumb, passes laterally around the distal forearm to reach the anterolateral surfaces of the limb, and then continues proximally. It crosses the elbow, then passes up the arm into the triangular depression - the clavipectoral traangle (deltoperctoral triangle) between the pectorali major muscle, deltoid muscle and clacicle. In this depression, the vein passes into the axila by penetrating deep facia just ingerior to the clavicle."
This means that the cephalic vein extends the entire length of the upper extremity from the base of the thumb into the shoulder. The area of concern is the base of the thumb up the arm for 4-5 inches.
Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thanks!!!
Kathleen Wilson, CRNI