Bard Site-Rite Prevue

Asystole RN · Feb 7, 2013

It is a pretty decent low cost ultrasound for peripheral IVs. Out of all the peripheral IV imaging devices the Prevue is my favorite, MUCH better than the near-infrared imaging devices that are roughly the same price.

Where they get you is in the consumables, the gel cap.

If you are a small clinic that will rarely need an imaging device then there are less expensive alternatives but the Prevue is a great value.

FlyingScot, RN · Feb 7, 2013

Thanks for the input. I find the people who actually use it have the most valuable information. We looked at the regular Site-Rite but at 20k couldn't afford it. Our clinic is actually enormous, enormous as in I do approximately 7,000 accesses yearly (Medi-Port, PICC and PIV). We occasionally run into situations where we absolutely need an ultrasound to get an IV started and have to rely on the hospital PICC team to do it. They are frequently unavailable and the charge to the patient is atrocious. I expect if we have something like the Prevue available we will find ourselves using it more routinely which ultimately I hope will make things nicer for the patients. We will likely share this with 3 infusion areas that are on the same floor as our clinic. I've used most of the other cheaper devices (Veno-Scope and the like) and personally find them more trouble than they are worth.

Asystole RN · Feb 7, 2013

Cost has always been the single factor holding back ultrasound...until the Prevue. I do not know how the cost centers work at your hospital but individual units at my hospital can direct order any supplies or equipment under $10,000. 5k is a convenient number.

FlyingScot, RN · Feb 7, 2013

Our limit before it goes into Capital Budget is 5k. My Bard rep quoted us $4,995 to keep it out of Capital. If the other units agree we will be splitting the cost so each unit will be paying just a little over 1k which is easily doable. I think this is a very viable alternative to calling the hospital PICC team and having the patient accrue that charge. We will likely bill the patient for the gel-cap but not the procedure itself although my manager had dollar signs in her eyes when she thought about revenue capture with this. If we did bill for the procedure we could feasibly recoup the cost of the device in less than a year. We've already started discussions about writing a policy regarding its use (ie: 2 attempts then go to US).

Another question. Have you ever used the needle guide and do you find it beneficial? It looks like an interesting concept but not sure I like the idea of something mechanical taking the place of skill.

Asystole RN · Feb 7, 2013

I very rarely ever use the needle guide unless the depth of the vessel is greater than 1.5 cm, which we very rarely insert a peripheral greater than.

The needle guides are good for novice ultrasound users since handling the probe and penetrating the vessel can be a difficult task to master at first. Once you are comfortable with multitasking you do not need the guides anymore.

The Prevue is so easy to use that I would not personally employ it after two failed attempts but rather use it as a first line assessment tool if there are not easily palpated vessels.

Does your PICC team bill for peripheral IVs and vascular assessments? Ours does not unfortunately so our department takes it in the nose with regards to productivity.

FlyingScot, RN · Feb 7, 2013

Our PICC team charges $350 just to LOOK at the patient! And their availablility is limited since their primary responsibility is in-patient. The thought behind the two attempts is to do it only if we were to bill seperately for the procedure (the idea of which I am not a fan). If we only charged for the gel cap then we could use the device routinely and I think we will. The other nice thing is Bard has come out with a new mid-line catheter that is basically an extra long #20 catheter that can be left in for 29 days. It is designed to be placed in the basillic vein by ultrasound much like a PICC but you don't have to be PICC certified to insert it. Some of our patients are on long-term antibiotics or frequent chemo. The other nice thing is you CAN draw blood from it. Not like our current midlines.

Asystole RN · Feb 7, 2013

I don't know if you have used the PowerGlide yet but we have not had great success with it yet. They seem to have a rather high failure rate and do not do well in veins deeper than 1.5 cm. Those PowerGlides that we have placed also seem to have about the same blood draw rate of about 3-4 days as compared to other midlines.

Its a bit early yet in the trial but we are leaning towards the idea that if someone needs a midline then we just place a Bard Poly or a Bard Poly Per-Q-Cath.

Edit:

Do you know what the PICC team is billing for? Is it ultrasound vascular assessment?

FlyingScot, RN · Feb 7, 2013

Yeah, they're billing for just gracing us with their presence! Seriously, that's the consult charge and it goes up from there.

Edit to add:

The PowerGlide was the item I was talking about. Just forgot the name of it. Why do you think it has such a high failure rate?

Asystole RN · Feb 7, 2013

Hmmm, I'll have to see if we can start charging for assessments too.

There are a couple of reasons for our high insertion failure rate. The first, and most obvious, is a relatively high learning curve considering it is rather a large and top heavy device. The other issue is that the PowerGlide is a one shot deal, once you activate the guide-wire there is no going back and at $100 a pop failed attempts really add up. When you traditionally insert a midline using the modified Seldinger technique you have the ability to asses the vessel with the guide-wire, to check if you have correctly accessed the vessel with the needle. Sometimes the vessel layers will separate and your needle will get caught between the tunica media and adventitia/intima or you will hit some other structure that was not visible on ultrasound. When you push the guide-wire forward with the PowerGlide you only have about 1 cm worth of play and with the guide-wire being rather thin and super flexible you cannot adequately feel if there is resistance or not. Instead of the guide-wire serving as an assessment tool and guide, it is only a guide with the PowerGlide so you better pray that you have cannulated that vessel correctly.

The main advantage of the PowerGlide is the speed of insertion (about 15 minutes) compared to the time it takes to insert a traditional midline under max sterile (30 minutes) and the ability to power infuse.

FlyingScot, RN · Feb 7, 2013

Well, that makes perfect sense. I think most medical devices were designed with the perfect patient anatomy in mind. Like that ever happens. Is this something you have brought up with Bard? For us our mid-lines (I totally forget which model they are) are extremely delicate and you can't draw blood through them which is a big deal. Most of our patients get twice weekly (or more) blood draws.

dah doh, BSN, RN · Feb 8, 2013

We use sono-sites. Not sure about brand or model though. Our PICC nurses use a big one. Our Intensivists and residents use a different one that is more portable to help with central lines. Our charge nurse and some if the staff knows how to use the sono-site to start IVs. I saw an advertisement for a new device called accuvein that is small and portable for IV starts that is based on a different technology. I don't know the cost, but you should look into it.