Ultrasound Guided IVs

[dsforza]

Hello, I recently initiated an ultrasound guided IV program in my ED. Using U/S guidance, we are inserting 18g and 20g angiocaths of 1.88inch length, mostly into the basilic and brachial veins.

I have been noticing these lines are infiltrating more than I would like, and I am wondering if there is anyone else who had similar issues.

I have worked in improving techniques for confirming placement, and am working on site selection. However it seems that after an hour or so, the line could infiltrate. My suspicion is that being a deep vein, there is more tissue to dislodge the cath with arm movement.

I obviously like to correct this.

Any ideas, pointers?

[klone, MSN, RN]

Have you looked to see if there is anything in the literature?

[Loo17]

I found the article below to be quite useful.

Ultrasound-guided peripheral I.V. access: Guidelines for practice - American Nurse Today

[BrnEyedGirl, BSN, MSN, RN, APRN]

We started this in our ED a couple of years ago and had similar problems,...we finally enlisted the help of our PICC team to do the training and this problem has stopped. There is literature out there,...I'll see if I can find what we used.

[IVRUS, BSN, RN]

We have seen the same problem, but when you think about it, the vessels you are using are still in the arm/forearm and in no way will they have the flow rate that is seen in the axillary, much less the SVC. And, these low flow rate vessels, are running deeper in the body tissue, so by the time there is a problem, it is seeminly more severe than the more superficial peripheral veins. So, pay attention to the osmolarity and pH of the infusate and follow INS standards.