I have read the other posts here regarding ultrasound guided peripheral IV sticks. I am looking for any information to help support this issue. We are a vascular access team and we round on all central lines and place picc's. Over the past 6 months or so we have been getting numerous calls for "difficult IV" sticks. We are only a 3 person team, we always work alone, we work 12 hour days 7 days a week and cover call on the off shift. At first the calls were for the cardiac cath patient that they couldn't get and those patients usually have their procedure then are discharged the same day. The calls are out of control now. We are getting called for ICU patients, patients on pressors etc. My experience with them is I am usually able to place one but they don't seem to last long. The line usually lasts 48 hours or so. Has anyone had any experience with the Prevue machine that is made for peripheral IV sticks? I saw the machine and it looks nice, there is a needle guide included so that makes it easier to not try to hold US while not moving. They are not willing to purchase that right now for us. I am looking for any help as I try to say we should or shouldn't do these. They can be very time consuming being here alone along with the picc consults. We have said we are not doing them right now because they have gotten so out of control. Another thing I have experienced is that if we don't do the US peripheral they get a picc order and these patients are not all candidates for a picc. If the patient has a lot of abx, meds etc I do suggest something besides the peripheral. I am just frustrated, we run on bare bones here and we need to set it straight if we should do these or not or fight for the prevue? Thanks for any info
We perform as many difficult sticks with US as we do PICCs each month. We are a 700+ level 1 trauma center with an extremely challenging vascular access population. We use the same US that we do for the PICCS (Site Rite) We are on a major rampage about multiple sticks and traumatizing patients, inappropriate PICC orders and the such, sounds the same as you. there is only 6 of us, and we have been frustrated as well. I would rather get called for the sticks than have the patients traumatized and have nothing left for me to stick, and I would rather get the PICC order and decide whether or not the patient needs one. Many times I am getting IV requests when the patient actually needs a PICC. why are your placements not lasting? have you been trained properly to perform this service? It definitey is a skill that requires lots of practice. Lots of education needs to occur so that you can get some help, continue doing the sticks becasue there is clearly a need for the patient, keep track of your volumes, keep track of how many sticks is occuring before you are called, make sure your policies reflect INS standards, talk to your educators about the stiuation. In all likelihood, it is because the nurses do not receive the proper training and education in placing the IVs, and once they find out about you being able to place with US, its game on!! The Prevue is an excelent idea for the floors to have some superusers, so that you can get away from the sticks and have the time for your PICCs and other dutes. Taek it to the products committee with a educati=or chwho might be in your corner. Make sure the nurse managers are aware of the difficulty you are facing with the IV requests. PICC excellence has a PIV with US training and competency. You have to show where this will save them $, time and improved patient satisfaction and safety (less sticks, timely access...) in the long run. How much dollars are you wasting in multple stick attempts, how many PICCs are you not doing because you are busy with IV, promote patient safety and staff accountablility. this is a good month to start, its Vascular Access Month!! its a process you can not handle alone. Enlsit some support with Good luck!
Cheryl E. Aldo, RN, BS VA-BC
I hear the frustration in your message but I am seeing a very strong positive aspect of this. Your services are in extremely high demand. From a business standpoint, that is exactly where you want to be. The teams that last are the ones who step up to the plate and never say No, we can't do that! US is an acceptable method of insertion of PIV, great insertion success, however there is one study that validates what you are saying - they don't last. Almost half in the study I am thinking of had infiltrated within 48 hours. An infrared device, in my opinion, is a better tool for PIV insertion. It is hands free and allows for visualization of superficial veins that you can't see or feel. The downside is it is a piece of capital equipment in a price range similar to US. Document your workload and try to get additional staff added, if possible. Until that happens, you need to create some fair method to prioritize your calls based on patient need. You can turn this into a very strongly entrenched team providing the best service for your patients! Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I have used the Prevue that you speak of. I like the small probe, the already gelled and sterile probe covers (I want that for my SiteRite!), and the transportability of the machine, as well as the needle guide! And we have multiple choices depending on depth.
I worry about the infrared vein finder - we cannot tell if the vein is sclerosed or how deep it is or large (diameter) it is. Many staff have tried it with approximately a 60% success rate in accessing the vein. I do not have data showing how long the IV's lasted.
The Prevue has a few features I really like: It gives the depth of the vein; The computer shows the diameter of the vein and how much of a certain needle will occupy the vein (length and diameter). The needle guide is wonderful because it helps us to place the IV in the center of the vein. The ultrasound allows us to assess the veins and chose the best vein for the medication or treatment needed.
I currently use the SiteRite to insert IV's. The caveat is that the probe is heavy and many superficial veins are occluded, esp. those that are less than 0.5cm below the skin. Our lucky ICU allows me to borrow their Prevue when I'm desperate!