Scalp Vein Catheterization Technique

Locate the frontal, superficial temporal, or posterior auricular vein in the scalp (see the image below). To minimize the risk of leaving a visible scar, select a site that is behind the hairline. Shaving the site may be necessary to allow proper visualization and to properly secure the catheter once it has been inserted.

Place an elastic band around the patient’s head just above the eyes and ears from forehead to occiput, or occlude the vein proximally with the index finger of the nondominant hand (see the image below).

Clean the site of insertion thoroughly with antiseptic wipes. Use the thumb of the nondominant hand to secure the vein distally to the insertion site to prevent movement of the vessel.

Hold the intravenous (IV) needle and catheter in the dominant hand, parallel to the vessel, pointing in the direction of blood flow. Insert the needle into the vein, angled 20-30º off the skin surface (see the image below). When the needle enters the vessel lumen, a flash of blood should be seen in the hub of the catheter.

Carefully lower the needle and catheter until they are just off the skin surface, and advance slightly further into the vein so that both the needle and the catheter tip are in the vessel lumen (see the image below).

Slide the catheter forward off the needle using the nondominant hand while continuing to hold the needle in place with the dominant hand (see the image below).

Once the catheter has been advanced completely into the vein, secure the catheter with the index finger of the dominant hand by compressing the skin overlying the vein where the tip of the catheter lies. Use the middle finger of the same hand to compress the vein immediately proximal to the catheter tip to prevent bleeding from the IV line while the needle is removed.

Attach extension tubing preflushed with saline and a saline-filled syringe (see the image below). Gently inject saline solution into the catheter, and observe for any infiltration into surrounding tissues.

If no infiltration is seen, secure the catheter in place with a clear, sterile adhesive dressing (see the image below). This prevents manipulation and contamination of the entry site and allows visualization for frequent assessment. Place rolled 2 × 2 cm gauze under the catheter hub to prevent pressure on the underlying skin.

Secure the extension tubing onto the skin with tape (see the image below).

Pearls

Shaving the site prior to catheterization makes taping the catheter in place easier and more secure.

Carefully warming the site before attempting catheterization can improve vasodilatation and make catheterization easier. Caution is necessary to prevent burns.

Attaching a piece of tape to the elastic band tourniquet (see the image below) facilitates removal while decreasing the chances of inadvertent disruption of the vein or the catheter.

Keep in mind that tourniquets are more likely to disrupt the scalp veins than vessels at other peripheral sites.

Attempting to advance the catheter over the needle before the catheter tip is in the vessel lumen can push the vein off the needle and prevent successful catheterization.

Hematoma is reported as the most common complication from peripheral IV catheterization; fortunately, it is often insignificant. ^{[4, 5]} Vasospasm is also a common complication and usually is significant only insofar as it makes successful catheterization difficult. ^[4]

Less common but more significant complications include the following:

• Phlebitis ^{[4, 6, 7, 8]}
• Infection ^{[4, 6]}
• Embolization of air or clots (possibly to cerebral veins) ^{[9, 10]}
• Injury to adjacent structures (artery or nerve)
• Infiltration of subcutaneous tissues with IV medication or fluids, which may result in superficial blistering, deep tissue necrosis, or tissue calcification if calcium-containing fluids are used ^{[4, 6]}

Accidental intracranial infusion of parenteral nutrition in a preterm neonate has been reported. ^[11]

A retrospective review by Callejas et al compared complication rates for peripherally inserted central catheters (PICCs) in neonates via scalp (69 insertions), upper-limb (471), and lower-limb veins (149). ^[12] The complication rate for insertion via scalp veins was 23%, compared with 23% for upper-limb veins and 15% for lower-limb veins. Central line–associated bloodstream infection occurred at a rate of 4.4 per 1000 catheter days with scalp-vein insertion, compared with 6.4 per 1000 with upper-limb insertion and 3.4 per 1000 with lower-limb insertion.

With PICC use, migration of the catheter tip may lead to complications. For PICCs inserted via the scalp, serial follow-up x-rays, beginning 1 week after insertion, may be helpful in detecting catheter-tip migration and identifying patients at risk. ^[13]