Is anybody using an ultrasound machine (like the Sonosite) for finding/starting peripheral IV's.

I did my first one the other night, deep brachial in a man who had bilateral forearm trauma and marked edema from overzealous crystalloids (when he had a prior IV that blew).

Worked great.

Andrew Bowman

Apparently yes, because I just had a PICC placed in my left arm using an ultrasound (dunno which brand). A whole bunch of nurses and folks had looked my arms over and decided that it would be best to send me downstairs to angio/radiology to get it placed. Took about 45 minutes. I couldn't see too much, obviously, but what I did see of the ultrasound display looked rather neat and interesting.

Seems to be working pretty well so far, tho I certainly don't plan to volunteer for any future placements! :imbar

Tom

I should have clarified it better. Are any NURSES using ultrasound to assist in placement of peripheral IV's?

Thanks.

So far they've only trained the nurses who work in Vasc lab to use the sonosite, but rumor is that those of us in the ER will be trained next. We've only utilised this method a few times, but I will say, one of our frequent fliers who has NO veins (we can SOMETIMES get a 22 into her) had an 18 placed in just a few minutes with the U/S. I was very impressed.

OUr IV therapy team (RNs) uses US for peripheral IV placement on difficult sticks...

I should have clarified it better. Are any NURSES using ultrasound to assist in placement of peripheral IV's?

Thanks.

What area do you work in? Adult or pediatrics or both? Just curious generally in pediatric to place a peripheral IV that is a hard stick we use a transilluminator light which works great but you need a few hands to hold the light and the paitent. To use the ultrasound for a peripheral tells me you are looking deeper that peripherally. Ultrasound takes practice to use but is generally better for larger patients and even better for Central line insertions.

I work at a Level One Trauma Center also a teaching facility; I have been initiating peripheral IV's with the sonosite "ilook" and the Titan going on the second year now.

It is awesome!

Theta Coker

Is anybody using an ultrasound machine (like the Sonosite) for finding/starting peripheral IV's.

I did my first one the other night, deep brachial in a man who had bilateral forearm trauma and marked edema from overzealous crystalloids (when he had a prior IV that blew).

Worked great.

Andrew Bowman

Yes, what a lucky person to get to use the Titan. Wouldn't we all love to have one of those. Sonosite is the best by far, whether you get a Titan, Sonosite 180 Plus, or go to Boston Scientific (who bought the ilook from Sonosite) to get the ilook. I like their clarity and screen depth the best of all the different Ultrasounds I have used.

we have been using ultrasound for peripheral iv access for several years now. I started this several years ago in the ER for a patient that we knew very well. It has been a life saver! It has also increased our skill level on the machine.

SUE:yeah:

Yes but only our IV nurses ( i am one of them) have been doing it for several years now. I want to point out that there are a few things one needs to be aware of before doing this advanced practice procedure. You must be very thoughtful in your vein selection and catheter selection when you use the US to place pivs ESPECIALLY in the upper arm and in the brachial vein. You must be proficient in IV cannulation and know the anatomy of the upper arm very well. Here is why and here are the recommendations that vascular access nurses are recommending. The lower forearm does not pose a big problem b/c these veins are very shallow unless you get near the radial nerve. If you must use the upper arm the basilic is a much safer choice,though this can be deep sometimes as well. The brachial is not recommended for routine piv use unless you are just using it for a one time med or CT injection and then take it out. If there is nothing else to use...the patient needs a PICC or some other type of access. The infiltration or extravasation is very difficult to detect b/c of the depths of these veins and somewhat due to the angle of the catheter...so that by the time they are discovered they are severe and in an area that may cause nerve damage or a compartment syndrome. In addition,some nurses are using a short catheter (ie. 1 inch to 1 1/4 inch) and by the time the vein is hit very little catheter is actually in the vein,further increasing the chance of infiltration and leaking. We use a 1 3/4 inch and a 2 1/2 inch catheter and have greatly decreased that problem. ALL the ED journals are also recommending that a longer catheter be used on the deeper veins. Our sites were leaking within 24 hours of placement with the shorter catheters. We actually do not use the brachial for piv placement unless it is a one time use and we NEVER place it for CT contrast (though I am sure it happens) which if extravasted could cause severe damage in that area. You also must be able to identify the nerve bundles and avoid them...if you hit one...your pt usually tells you.....take it out immediately. SO proceed with caution and make sure you know what you are doing b/c while this is a wonderful tool it does take some skill and thoughful nursing care and judgement.

I have been using the ultrasound to place PIV for about 6 years now. I starting when I was evaluating ultrasound that were going to be used for PICC placement which I had not gone to the training program yet, so I needed some way to get an idea of use. So I started on patients that I could have techniquely obtained without the ultrasound. that way I could see the relationship between the ultrasound and the vein. Now I work for solely for a PICC team and have been training the nurses in certain areas to use this tool with strict policy and guidelines. I Have taught some staff nurses in a level one trauma to use their ultrasound for this since we do not have an IV team at this hospital. The clinical coordinator of the Trauma and myself have designed a policy and procedure explaining the ins and out. For these PIV we are using a longer needle sometime because these veins are deeper in orientation with the ultrasound. One needs to be mindful of how much catheter will sit within the vein, this is crucial to the life of the catheter. Currently we are tracking these PIV to see the life of them and to monitor for complications. I think this procedure is ideal for procedural areas and need more caution with in patient settings.

Also be aware that recent studies show about a 50 percent failure rate of US guided PIVs within 24 hrs. I have found this to be true in my practice setting as well. These lines need to be considered a "bridge" line to a more appopriate access forthe patient that usually has very limited suitable veins for peripheral therapy.

Hello Madam PICC and Iluvivt,

We are looking at developing a policy in our institution at this time for Ultrasound guided PIV's. Would it be possible to have you send me(or direct me to) your policies for this procedure? We are venturing out and want to start it off on the right foot.

Thank you

Warren