I think the AVA is overthinking this one. The low res image doesn't allow them to say with certainty where the IV needle ends. If I had to guess I would say it ends where the tape ends, which is well above the wrist. Whoever does the IV is probably going to do what they are most familiar and comfortable with, and in the case of hospital nurses that usually means starting distally so that you have other options if you need them (if you start in the forearm or elbow joint and need to redo it then you have fewer options). Hand is also preferred to upper forearm because it's less susceptible to movement (despite what the AVA thinks it can read about the needle being too close to the wrist). Much ado about nothing, methinks.