Long angiocaths

[CraigB-RN, MSN, RN]

We've recently started using portable ultrasound for difficult peripheral IV access. In a past hospital we had longer angiocaths for deep brachial access. Can't seem to find a source for them now. Does anyone have any suggestions on sources or alternatives?

[iluvivt, BSN, RN]

Yes I do know where you can get these but this practice concerns me as well as the entire IV therapy community that sets standards of practice and I will explain why!!!!

1. First.....you can use US to access veins BUT there are many drawbacks and safeguards and standards that need to be in place before RNs do this and only RNs that have US skills and proven competencies should be allowed to perform this skill
   
2. Short PIVS that have been started with a bedside US have a very high incidence of infiltration/extravastion AND if not monitored frequently and with the knowledge of this and how to assess these special IV sites... awful complications can and do happen
   
3. It is recommended that only the veins of the lower forearm and the basilic vein (only slightly above the ACF) and upper cephalic be used and NEVER the Brachial vein and especailly NEVER EVER for a power injection or for any type of vesicant. There are some very rare circumstances when we have used the brachial vein for a one time dose and then d/ced the access and this was with a radiologist present but basically never is the best decision
   
4. The nurse inserting any IV access with US needs to be able to identify the compressability of the selected vein..any nerve bundles ...and the arteries
   
5. If someone is going after the Brachial vein for access b/c they can get no other peripheral access..then the patient really needs some other type of access such as a PICC or other type of CVC
   
6. It has bees suggessted that any suitable vein ( not the Brachial) that will be accessed with US be no deeper than about 1 cm from skin level as this will minimize the potential for infiltration. The lawsuits that will occur in these situations if prudence does not prevail will be nerve injuries and damage and compartment syndrome and DEEP extrvasation injuries if any vesicant type meds are administered . Believe me..they will get an IV expert like me to testify against you and you will have NO LEG to stand on. So this practice must be done carefully and with skill and knowlege behind you. We only allow our PICC nurses to perform the procedure and we ALL follow the guidelines I have set up. WE have had to train our nursing staff on how to monitor these sites as well. We also review the pts IV needs and often will suggest a PICC or alternate IV access if he pts needs will extend past 24 hours
   
7. Once you have policies and procederes and competencies in place...you can use a PIV cannula that is longer...BUT it can not be longer than 3 inches as then it is classified as a midline catheter...if you would like to PM me I can give you the products we use BUT you need to check on the policies in your facility and see if they are consistent with the current standards. I will also check to see if there is anything new since I last verified this information and I will post again
   

[CraigB-RN, MSN, RN]

Thanks for your response. I used your concerns to look at my policy and discovered the area's that it is lacking. Sometimes we're to close to the problem and it takes someone from outside to point things out.