Preferred Veins for Peripheral Intravenous(IV) Catheter Insertion for Neonates

Compared with adults, the veins in babies are smaller and hard to find. They are poorly supported by surrounding soft tissue. However, it is essential to find a suitable vein for cannulation that a premature or sick infant requires in the clinic.

Where can you find the veins for IV cannulations?

1. Hand - Dorsal arch veins and Cephalic vein

The dorsal arch veins are best seen on the back of the hand. IV insertions here are easily splinted and any infiltration is easily detected, so these veins are the preferred sites.

The cephalic vein is often quite large and it is better to be felt than seen. If you need to cannulate in a large baby, it is one of the veins to try. Intubation in this position tends to last a long time, making it a good secondary position.  

2. Wrist

Veins on the volar side of the wrist are easily seen. They are easy to be cannulated but do not last well.

3. Cubital fossa - Median antecubital, cephalic, and basilic veins

These veins are large and easy to hit for both adults and neonates. They are preferred sites for IV insertion and phlebotomy. But please note that both the median nerve and the brachial artery are near the same anatomy and are therefore vulnerable to injury.

4. Foot - Dorsal arch and saphenous vein

The dorsal arch vein is small but easy to cannulate and surprisingly well. The vein on the lateral side, below the ankle bone, is easily accessible but must be clipped carefully and seep through.

The saphenous vein runs reliably anterior to the medial malleolus, being large and straight. While not always easy to see, it is easily accessible and long-lasting. These veins are also good locations for the insertion of percutaneous central catheters and again should be avoided in infants who may require long-term venous access.

5. Leg - Saphenous vein at the knee

Similar to the saphenous vein on the foot.

6. Scalp - superficial temporal vein

Scalp veins should only be used after other alternatives have been exhausted. In most cases, at least a partial shave of the head is required.

The superficial temporal vein runs in front of the ear and is palpable within 5-8 cm in most infants, and it lasts a long time if properly secured. This vein is also a good location for a percutaneous central catheter and should be avoided if possible in infants who may require long-term IV access.

It is not easy to get skilled IV insertion, catheter, or injection techniques for neonates. We believe if there is a realistic infant head, pediatric IV arm, or IV leg simulator with correctly positioned veins, that would be better for nursing students, nurses, or doctors to hone their clinical nursing skills effectively.

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