Use of Ultrasound Guidance for PIVs

[bgxyrnf, MSN, RN]

Some of you may be following a thread that I started about the longevity of peripheral lines (https://allnurses.com/general-nursing-discussion/whats-your-longest-1169156.html). Some people have expressed shock in reading that I have a PIV that's been in place for over 40 days (and counting).

The vast majority of the peripheral lines that I place are for a specialty service that starts lines on "hard sticks." Nearly every line I place is a long catheter placed with ultrasound guidance, a skill that I acquired as an ED nurse and which I continue to practice for patients on the floor (mostly because the floor nurses have neither the equipment nor the experience).

It got me to thinking... how often are your peripheral lines started with ultrasound guidance?

In addition to longevity, I've begun tracking times when I've been able to avoid a central line for a patient by securing stout peripheral access via ultrasound guidance and in the short time that I've been looking at it, I'm up to three - one of which was going to be a femoral line, which is the highest risk central line there is (from what I've read).

I'm really starting to wonder how many avoidable central lines are being placed simply because no expert user is available to seek access with ultrasound guidance.

[Guest374845]

There are multiple papers published citing CVC and PICC rate reductions of 70-80% at major US medical centers. I can't find it but my ED published some data as well. Ultrasound makes a huge difference, but getting a large enough percentage of staff to enthusiastically buy into it has always been difficult.

[AceOfHearts<3]

I'm in the ICU so chances are really high that the patient is going to be a hard stick (because of disease pathology, chronically ill pt with poor veins, etc.). I'll look for a site and have another nurse look, then if we don't see anything we think we'll be successful at I page our IV team to put one in with ultrasound. I have the policy of not sticking my patients a ton of times because I wouldn't want to get stuck over and over again myself. I love our IV team nurses- we see them a lot in the ICU and they love us too.

[smf0903]

We do ultrasound guided IVs on those who are really tough sticks. Our ED nurses and those of us in ICU were trained on ultrasound guided insertion, so there's always someone in the facility who can be utilized for this. We don't do a ton of them, but it's sure nice to have available when needed!!

[Buckeye.nurse]

I work in hematology, so most of my patients who have an active treatment plan have some sort of central line. We have a 24/7 ultrasound team available for consult though (part of our float pool). They are a fantastic resource for benign heme patients, or those few oncology patients who don't have a line for whatever reason.

[MikeyT-c-IV]

I've been placing USGPIV's for about 11 or 12 years. I'm on a vascular access team. I started using ultrasound a couple of years before I started placing PICC's and midlines. I haven't kept track of how many central lines we have avoided due to utilizing ultrasound, I imagine it has been quite a lot. I have been pushing leadership to give us some hours to train more nurses on the ultrasound, but you know... money is always tight.

Good job on keeping track of your stats and choosing the most appropriate line for your patients!

[bgxyrnf, MSN, RN]

I've been placing USGPIV's for about 11 or 12 years. I'm on a vascular access team. I started using ultrasound a couple of years before I started placing PICC's and midlines. I haven't kept track of how many central lines we have avoided due to utilizing ultrasound, I imagine it has been quite a lot. I have been pushing leadership to give us some hours to train more nurses on the ultrasound, but you know... money is always tight.

Good job on keeping track of your stats and choosing the most appropriate line for your patients!

Thanks for your reply, MikeyT. Some folks around our facility are pushing to train and equip some nurses on the floors though from my personal experience w/ USGPIVs (~6 years), it's a perishable skill that takes frequent practice to acquire and maintain expertise. Outside of the ED (where I first learned), that's hard to imagine.

[mrsboots87]

I'm on a tele floor. I place anywhere from 1-5 regular IVs a week and at least 2-3 if not more US IVs a week. I think the most US IVs I've places in a day is like 5. I got certified about 6 months ago. It think it's a great skill to have and more people should get certified. I'm very good at regular IV insertion but still miss sometimes. I've missed maybe 1 in 200 US IVs and it was a person with absolutely horrid vasculature.

IV insertion is my favorite thing and I'll stick just about anyone. You only get better through at least trying. My hospital system doesn't use nurses in the line team or that would be my goal.

I think more people should learn how to US guide IVs, but also agree there's no use in everyone in a floor doing it or there would be those who don't do it often enough to maintain there skill set.

I don't tack how long mine last, but I do know that I see a lot of my labels around my unit that have been in patients over a week if they are there that long. Most of our 1" PIVs don't last more than a couple days.

[EllaBella1, BSN]

I place ~90% of my PIVs by ultrasound. I'll admit, I suck at peripheral IVs when I'm just doing a blind stick. Unless the patient has like bodybuilder-esque bulging pipes for veins, ultrasound it is. With the ultrasound I can get an IV on my first try most of the time, even on tricky sticks. Plus it allows me to look for sites that aren't ACs, and allows me to use a bigger gage than I probably would have attempted otherwise. I was taught how to use the ultrasound by a coworker who used to work on IV team, and I've taught probably 5 people in return. I agree that it should be a skill that more of us can perform.