Inserting a peripheral intravenous (IV) cannula is a routine clinical task, yet small details during placement can impact its function, comfort, and longevity. One such detail is the direction in which the IV catheter should face after insertion. While this might seem trivial, the orientation of the catheter relative to the vein and the patient’s body can influence flow rates, patient movement tolerance, and the likelihood of complications like infiltration or kinking 1,2.
Most IVs are placed in the upper extremities, especially the dorsum of the hand or forearm. The tip of the catheter ideally lies within the lumen of a superficial vein, parallel to blood flow. However, how the external portion of the IV is secured can determine how well the IV handles physical movement and whether it is likely to dislodge or kink during use.
Traditionally, the IV catheter should face proximally—pointing up the arm toward the heart. This aligns with venous flow and reduces the likelihood of mechanical resistance during infusion. It also ensures that the catheter follows the natural course of the vein, minimizing the risk of puncturing through the vessel wall during insertion or later movement 3,4.
In clinical practice, this is also helpful for ease of access and patient comfort. On the forearm or hand, orienting the IV catheter to face proximally, toward the elbow, generally allows for smoother taping and better stabilization. When the catheter hub and tubing extend in the direction of natural limb movement, such as elbow flexion or wrist extension, there is less tension on the insertion site and a reduced risk of dislodgment.
Conversely, placing the IV catheter to face distally, toward the wrist or fingers, is typically discouraged. This configuration may introduce tension at the insertion site when the patient moves, increasing the risk of infiltration, kinking, or vein irritation. Distal-facing IVs are also harder to secure because the tubing runs counter to the natural direction of movement, making accidental tugging more likely 5,6.
There are scenarios where distal-facing IVs may be unavoidable, such as when vein anatomy or scarring limits available sites. In these cases, extra care must be taken with securement, and the IV should be monitored more closely for signs of malfunction or infiltration. Similarly, in emergency situations or in patients with limited access, priority is often given to successful cannulation over ideal orientation. But in planned or elective settings, proximal orientation remains the standard 7,8.
While the direction an IV should face may seem like a minor technical detail, it plays a significant role in the success and safety of peripheral IV access. Attention to this clinical detail can ultimately extend the functional life of the IV, enhance patient comfort, and reduce the risk of complications.
References
1. O. R. for N. (Open, Ernstmeyer, K. & Christman, E. Chapter 1 Initiate IV Therapy. in Nursing Advanced Skills [Internet] (Chippewa Valley Technical College, 2023).
2. Beecham, G. B. & Tackling, G. Peripheral Line Placement. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2025).
3. Insertion of IV | College of Nursing | ECU. https://nursing.ecu.edu/cils/insertion-of-iv/.
4. Ultrasound-Guided Peripheral IV Insertion, Placement, and Access Made Easy. POCUS 101 https://www.pocus101.com/ultrasound-guided-peripheral-iv-insertion-placement-and-access-made-easy/.
5. Intravenous Cannulation Technique: Approach Considerations, Insertion of Intravenous Catheter, Removal of Intravenous Catheter. https://emedicine.medscape.com/article/1998177-technique.
6. IV Angle of Insertion: Clinical Tips | @LevelUpRN. (2022).
7. Ford, C. A guide to cannulation in adults. British Journal of Nursing https://www.britishjournalofnursing.com/content/back-to-basics/a-guide-to-cannulation-in-adults/ (2023). DOI: 10.12968/bjon.2023.32.19.S6
8. Difficult Cannulation, a Practical Guide to IV Access. MedCourse https://medcourse.co.uk/career/difficult-cannulation-iv-access/ (2023).
