What access method has the highest risk for venous irritation during a continuous infusion of fluorouracil?

The access method identified as having the highest risk for venous irritation during a continuous infusion of fluorouracil is the new 18-gauge peripheral IV requiring multiple attempts. When administering chemotherapeutic agents like fluorouracil, peripheral IVs are most susceptible to complications such as phlebitis, infiltration, or extravasation, particularly when the IV placement is not optimal.

The repeated attempts to establish an IV can cause trauma to the surrounding veins, leading to local irritation and inflammation. An 18-gauge catheter is larger in diameter, which can enhance the risk of venous irritation compared to smaller gauges, particularly if the vein is not healthy or if there is a significant volume of blood flow. Continuous infusion further increases the risk of chemical irritation of the vein lining since fluorouracil is a potent cytotoxic agent.

Other access methods, while they do present some risks, are generally associated with lower rates of venous irritation. An implanted vascular access device placed three years ago is designed for long-term use and usually presents minimal irritation as it is positioned centrally, effectively reducing exposure of the vein to irritants. A recently inserted midline catheter and a peripherally inserted central catheter (PICC) are also designed to minimize