Ultrasound Guided IV insertions

  1. Hi,

    I work in a level one trauma centre in an area that sees patients with multiple comorbities and complex health histories. We have a lot of dialysis patients and IVDA patients, so plenty of hard IV starts. I took a course offered my hospital three months ago to learn how to start U/S guided IVs that's as taught by a few of our ER docs as nurses who are certified and signed off on after taking this course are able to perform the procedure. I was doing really well on my own until the last couple weeks and I've hit a rough patch where I wasn't able to get 5 or 6 people in a row. I'm frustrated and unsure how to go about improving. I don't want to turn my patients in to pincushions as U/S IVs can be quite painful. I'm pretty proficient with regular IV starts and did fine learning how to do EJs and rarely struggle with those. Any suggestions or tips would be appreciated. I looked online and there doesn't seem to be many resources to help. Thanks.
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  2. 19 Comments

  3. by   wyosamRN
    At what point are you having trouble? Puncturing the vein, advancing the cath, locating a suitable location?
  4. by   offlabel
    You took the course and have been successful... don't sweat it. You've gone past the 'honeymoon' phase and now it's real. Dry patches are common. Watch other people doing it or YouTube a couple.

    Also, for a while you should be more conservative in your vessel selection. Don't even try the smaller ones for a while.

    Lastly be sure to use a lot of local... like 2-3 cc of at least .5% lido. Makes it painless and that means less stress for you.
  5. by   brewski09
    I echo the question of what part are you having difficulty with because there are bound to be plenty of certified people on here that might be able to help with more info.

    I've yet to use any lido or other pain mitigating mess for U/S PIV insertion (it isn't in our standard practice for adult patients) and many of our patients thank us for getting an IV so they don't have to get poked again.
  6. by   pluckyduck
    I would say occasionally puncturing the vein but mostly advancing the catheter once I get flashback. I think I'm hitting the wall of the vessel--just on top, or the side. I try to pull back and change my angle and readvance but no luck. And I'm not allowed to use lidocaine unfortunately, it's not in our standard practice at my workplace. :/
  7. by   Kuriin
    My HCAHP paper was based on USGPIV and pain reduction and no where in all of my research did hospitals mention they use lidocaine before.
  8. by   MikeyT-c-IV
    I've been using ultrasound almost exclusively for PIV's for about 8 years (they call me for the difficult starts). My advice is to just keep practicing. It takes a while to get really good.

    My biggest pointer is to practice at knowing exactly where the tip of your needle is. Learn to point and move the probe along with the needle tip as you advance to and in the vessel. I sometimes can see my needle tip hit the back side of the vein so I can see I need to back up just a hair so that the catheter will advance.

    Good job, BTW, for taking the initiative and learning the skill. It's tough at first but your patients will love you for it.
  9. by   offlabel
    Quote from Kuriin
    My HCAHP paper was based on USGPIV and pain reduction and no where in all of my research did hospitals mention they use lidocaine before.
    I don't know what HCAHP or USGPIV are, but I know that using lidocaine for any IV in an awake patient is humane, very safe and a good idea. RN's use it on our labor and delivery units, and all of our pre-procedural areas.

    It makes a big difference in our patient satisfaction scores that the hospital pays attention to.
  10. by   Bobjohnny
    Quote from offlabel
    I don't know what HCAHP or USGPIV are, but I know that using lidocaine for any IV in an awake patient is humane, very safe and a good idea.
    Ultrasound Guided Peripheral IV? No idea what an HCAHP is.

    Y'all really use lido for every IV insertion? That seems excessive, at least to me, but to each their own. My thought process for this has always been, "Why get stuck twice when you can get stuck once?" But, its not within our standard protocols & we'd have to obtain an order every time we do it.

    Anecdotally, it seems as if the few times I've interacted with people that use lido consistently have lower success rates. But, this is also just when pre-op can't get an IV and calls the ED (the lido is in their protocols).
  11. by   offlabel
    Quote from Bobjohnny
    Ultrasound Guided Peripheral IV? No idea what an HCAHP is.

    Y'all really use lido for every IV insertion? That seems excessive, at least to me, but to each their own. My thought process for this has always been, "Why get stuck twice when you can get stuck once?" But, its not within our standard protocols & we'd have to obtain an order every time we do it.

    Anecdotally, it seems as if the few times I've interacted with people that use lido consistently have lower success rates. But, this is also just when pre-op can't get an IV and calls the ED (the lido is in their protocols).
    A slow injection with a 27 ga needle for a lidocaine wheal is pretty painless compared to an IV catheter, especially big ones. When you use buffered lidocaine, there is hardly any sensation at all. When I can, I place 16 or larger pretty routinely and I wouldn't put patients through that without a good reason.

    Many years ago I wouldn't use any anesthetic because no one else did and pain with getting an IV was just taken for granted. Now I wouldn't think of not using lido in an awake patient. They're stressed out enough as it is.
  12. by   AZQuik
    Are you using a cross sectional view or longitudinal view?
  13. by   NickiLaughs
    Quote from offlabel
    I don't know what HCAHP or USGPIV are, but I know that using lidocaine for any IV in an awake patient is humane, very safe and a good idea. RN's use it on our labor and delivery units, and all of our pre-procedural areas.

    It makes a big difference in our patient satisfaction scores that the hospital pays attention to.
    I'm guessing you guys have this as a protocol? Lidocaine is viewed as a med and without either an order or as part of a protocol we can't go grab lido for everyone's IV. In the ER that's not really always an option (traumas, emergent cases, etc) very few of our IVs are "routine." I'd be interested in knowing how often this is being used in hospitals. We do use EMLA for peds though if they're stable enough.
  14. by   offlabel
    Quote from NickiLaughs
    I'm guessing you guys have this as a protocol? Lidocaine is viewed as a med and without either an order or as part of a protocol we can't go grab lido for everyone's IV. In the ER that's not really always an option (traumas, emergent cases, etc) very few of our IVs are "routine." I'd be interested in knowing how often this is being used in hospitals. We do use EMLA for peds though if they're stable enough.
    It's just a matter of putting a nursing policy in place that gets cleared through all of the usual channels. If the docs don't think it's worth it, it won't happen, but I'd guess they'd want it for someone they cared for.

    Obviously, it isn't for the patient with a hole in his liver, but for that poor patient with renal stones, or hyperemesis, or having an MI, it's a good thing. There is this skin refrigerant out there that works real well that you just spray on and it gives great anesthesia for a couple of minutes.


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