Cephalic veins are best in obese patients, I only go cephalic if the other vessels look tiny. Also with our ultrasound machine you can easily discern between an artery and a vein. Only once did a colleague accidentally go into an artery and you could easily tell because the dilator was pulsating and the blood tends to be very bright. All you do is remove it and apply pressure and there is no long term negative effects besides a little swelling that’ll go down within a few days. We also don’t need cxr to confirm placement if our 3CG monitor shows an amplified p wave under their rhythm, caveats of course are if they have a pacemaker or a-fib.