What veins should not be used for IV? A Guide to Safe Vascular Access

September 26, 2025 •

4 min read

According to the Infusion Therapy Standards of Practice, proper peripheral intravenous (IV) access site selection is a critical component of patient safety. Knowing exactly what veins should not be used for IV insertion is essential for preventing painful complications such as infection, infiltration, and nerve damage.

Quick Summary

Certain veins should be avoided for IV insertion due to high risks of complications, including veins in the lower extremities, compromised or damaged veins, and those near joints or major nerves. Careful selection is vital for a safe procedure.

Key Points

Lower Extremities: Avoid veins in the legs and feet due to a higher risk of blood clots and embolisms.
Compromised Veins: Never use veins that are bruised, infected, or feel hard and rope-like from past damage.
Joints and Flexion Points: Avoid areas like the inner elbow and wrist where movement can dislodge the IV catheter.
Medical Conditions: An arm with an arteriovenous fistula, lymphedema, or a history of mastectomy should not be used for IV access.
Difficult Access: Utilize imaging technology or consult a more experienced clinician when veins are hard to find, rather than attempting on a compromised site.

Why Proper Vein Selection is Crucial for Safety

The process of inserting an intravenous catheter, or IV, is a common medical procedure, but it is not without risks. Choosing the right vein is a skill that healthcare professionals meticulously practice to minimize the potential for patient harm. Using an unsuitable vein can lead to a host of problems, from minor discomfort to serious, long-term complications. These issues can include phlebitis (vein inflammation), infection at the insertion site, nerve damage, infiltration (fluid leaking into surrounding tissue), and even embolism in the lower extremities. Knowing what to avoid is a fundamental aspect of providing safe and effective care. This guide outlines the key areas and conditions that make a vein inappropriate for IV access.

Veins to Strictly Avoid for IV Placement

Certain areas of the body and specific vein conditions are considered major contraindications for peripheral IV placement. Adhering to these guidelines helps prevent complications and ensures a successful procedure.

Veins of the Lower Extremities

Infusion Therapy Standards strongly advise against using veins in the legs and feet for routine peripheral IV access in adults. The primary reason for this is the significantly higher risk of thrombophlebitis, which is the inflammation of a vein due to a blood clot. If a clot dislodges, it could lead to a pulmonary embolism, a potentially life-threatening condition. While they may be used as a last resort in some emergencies, lower extremity veins should be avoided whenever possible.

Compromised, Damaged, or Sclerosed Veins

Compromised veins are a major reason to seek another site. This includes veins that are:

Sclerosed: Hardened or scarred, often due to repeated punctures or prior IV drug use. These veins are difficult to penetrate and increase the risk of rupture.
Bruised: Puncturing a bruised area is painful and can lead to further tissue damage and hematoma formation.
Phlebitic: Showing signs of inflammation, such as redness, warmth, or tenderness. Using an already inflamed vein will worsen the condition and increase patient discomfort.
Previously Infiltrated or Extravasated: An IV should not be placed in a vein that has recently experienced infiltration (leakage of non-vesicant fluid) or extravasation (leakage of vesicant fluid, which can cause tissue damage).

Areas of Flexion

Veins in areas that bend and move frequently, such as the antecubital fossa (the inner elbow) and the inner wrist, should generally be avoided. Catheters placed here are prone to occlusion and dislodgement when the patient moves their joint, which can disrupt the infusion and cause complications. While the antecubital vein is large and often visible, it is not ideal for IVs requiring a longer dwell time.

Areas with Infection, Burns, or Massive Edema

Inserting an IV through infected, burned, or severely swollen (edematous) tissue is strongly advised against. Doing so can introduce bacteria directly into the bloodstream, risking a systemic infection or sepsis. In edematous areas, swelling can obscure vein visibility and palpation, making safe insertion very difficult.

Extremities with Specific Medical Conditions

An IV should not be placed in an arm affected by a variety of conditions, including:

Mastectomy with lymph node dissection: This can disrupt lymphatic drainage, increasing the risk of lymphedema and infection in that arm.
Arteriovenous fistula (AVF) or graft: Used for hemodialysis, these are vital to a patient's treatment and must not be accessed for routine IV purposes.
Chronic kidney disease: Unnecessary venipuncture should be avoided in extremities designated for future vascular access.

Comparison of Appropriate vs. Inappropriate IV Sites


Feature	Appropriate IV Site (e.g., Forearm)	Inappropriate IV Site (e.g., Lower Leg)
Infection Risk	Low, when proper technique is used.	Elevated, particularly in the feet due to proximity to the ground.
Risk of Phlebitis	Lower due to larger, straighter veins.	Higher due to increased risk of clotting.
Stability	High; located away from major joints.	Low; high risk of catheter dislodgement.
Nerve Damage	Lower risk when major nerves are identified and avoided.	Higher risk in areas like the inner wrist.
Patient Mobility	Does not significantly restrict mobility.	Limits patient mobility and comfort.
Venous Blood Flow	High flow, reducing risk of stasis.	Slower flow in peripheral veins.

Assessment and Techniques for Safe IV Access

For healthcare professionals, a thorough patient assessment is the first step in finding a suitable IV site. For patients, understanding this process can provide reassurance and allow for informed questions. When standard sites are unavailable, specific techniques can be used to aid in a safe and successful cannulation.

Signs of an Unsuitable Vein

Feel: The vein feels hard, ropey, or thrombosed instead of bouncy and soft.
Appearance: The vein is bruised, discolored, or shows visible signs of infection like pus or redness.
Temperature: The skin over the vein is warmer than the surrounding tissue.
Patient Feedback: The patient reports pain or tenderness upon palpation of the vein.

Best Practices for Difficult Access

Start Proximal: When attempting an IV, healthcare providers should start with the veins in the hand and work their way up the arm. This strategy preserves more proximal (closer to the torso) veins in case the more distal sites are used up or fail.
Use Visualization Technology: Devices that use infrared light or ultrasound can help visualize veins that are difficult to see or palpate. Ultrasound guidance is particularly useful for difficult venous access and can increase the success rate of catheter placement.
Warm the Extremity: Applying a warm compress can help dilate veins, making them more visible and palpable.

For patients and healthcare providers alike, prioritizing safety means being informed and prepared. Understanding what veins should not be used for IVs is a vital part of minimizing risks and ensuring the best possible outcome for infusion therapy.

NCBI Bookshelf on Peripheral Line Placement

Frequently Asked Questions

IVs are not typically placed in the lower extremities for adults because these veins have a higher risk of developing blood clots (thrombophlebitis). This increases the danger of an embolism, which can be a serious medical event.

No, inserting an IV into an area with a local infection is not safe. It can push bacteria directly into the bloodstream, potentially leading to a more widespread and dangerous systemic infection, or sepsis.

The inner wrist is risky due to the high density of nerves and arteries in close proximity to the surface veins. There is a significant risk of causing nerve damage or inadvertently puncturing an artery, which can be very painful.

A sclerosed vein is hardened or scarred, often from repeated use or trauma. These veins are poor candidates for IV access because they are difficult to penetrate with a catheter and have an increased risk of rupturing or collapsing.

Following a mastectomy with lymph node dissection, lymphatic drainage in that arm may be compromised. Using this arm for IV access could increase the risk of infection, swelling (lymphedema), and further complicate the patient's condition.

If a suitable vein cannot be found, a nurse should not keep attempting in compromised areas. Instead, they can use visualization devices like ultrasound, apply warmth to dilate veins, and if still unsuccessful, escalate to a more experienced clinician or consider alternative access methods.

No, it is not safe. Inserting an IV into a bruised vein is painful and can cause further bleeding into the tissue, resulting in a larger bruise or hematoma. A new, healthy vein should always be sought.