peripheral iv's using ultrasound

[cupcake25]

I was wondering if anyone uses the ultrasound machine for very difficult peripheral sticks. I don't have that much experience using it but a few nurses on my iv team use it and place iv's in the ac space. I would say that about half of them infiltrate in just a few hours of insertion.

[StarlightRN]

I've never used one of the ultra sound machines, but it seems like if you were using one you could find a better place to put an IV than the AC. I will not place an IV in the AC if at all possible. Everytime the patient bends their arm it will occlude. It's so aggravating to the nurses and the patients to have to keep going in and turning the pump back on. It's just too hard for the patient to keep their arm straight. They come up to the floor all the time b/c the EMS, or ER has put one there. It's usually the fastest and easiest place to get one. We are suppose to save the AC to stick for labs. If they have an ultra sound machine why in the world would they start it in the AC. If it is an IV team seems like they would have more experience and be able to start one somewhere else.

[PICC ACE]

There are a number of reasons for those IV's not lasting. First is the site itself,as the AC area is too close to a 'joint flexion' spot and the catheter can work its way out too easily. Also,I think that nurses doing US for peripherals don't use the right angle of insertion. They use "PICC needle" angles,not PIV angles and also don't use a long enough IV cannula.Hence,the cannula comes out too easily.

[iluvivt, BSN, RN]

Answer to Cupcake 25s question. Yes you can use the US to place peripheral IVs,but like anything else you must do it thoughtfully and carefully and only those with excellent IV skills and US skills should be performing this procedure. This is what we found out through trial and error.

1. Avoid the use of the Brachial vein and the portion of the Basilic that is deeper. So in other words, only use these two veins in the lower portion of the upper arm. The Cephalic vein is OK to use b/c it stays fairly shallow all the way up the arm. The reason for this is b/c the inflitrates and extravasations that can occur at these sites are often difficult to detect. Once detected they are usually fairly large and the risk for severe complications,such as nerve injuries,regional pain syndrome,and other vascular complications is present.

2. We purchased a special long peripheral cannula (2 1/2 in) or the 1 3/4 in introcan. This dramatically decreased the early infiltrations and increased our dwell time

3. Be very careful when using any of these sites for CT contrast injection. Some say if you are going to use it for that purpose...use it ...then D/C it after use.

4. If the patients are that difficult to start...assess their need for future IV therapy and place a PICC or call MD to discuss the case. Sometimes pt only has one more day of tx left and in that case I would not suggest a CVC.

[momdogz]

AC would be last choice, and only for good reason.

Use longer IV cannulas: chances are if you're needing to use U/S to place a PIV, the vessel depth is greater. Using standard PIV lengths increases the complication rates d/t infiltration/extravasation.

[rnseb65]

We use ultrasound frequently for IV access. We generally place them in the upper arm/bicep area. This has been very helpful in the ER when someone with limited access needed a site quickly. It can be a lifesaver and help reduce repeated sticks. I also agree with others comments regarding placing in the AC. Why do that when you have US that enables you to find a vessel in a more convenient location. FYI, I always use a longer catheter when I use US.

SUE