What do you do when the opposite arm is not available for an IV at shoulder surgery?

We ask our anesthesiologists to have a secure 18 gauge IV before all major shoulder surgeries. Sometimes the opposite arm is unavailable because of post-mastectomy lymphedema or because the veins are all "used up".

In these situations, a option is to start an IV in the foot. We do not prefer this option because it is easy to dislodge after surgery and inhibits ambulation.

Our preference is an external jugular IV, which allows freedom of movement of all four extremities.
This can be inserted under local anesthesia or after anesthesia has been established with another small   peripheral IV.

Here's what it looks like

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We have a new set of shoulder youtubes about the shoulder, check them out at this link.

Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link

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How you can support progress in shoulder surgery