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Dialator PIV under Ultrasound for CT scan
today we had a pt who is a hardstick, and the nurse just used ultrasound and microintroducer kit to do the PIV. She first idetified the vein with ultrasound and set up the sterile field just like start a PICC line, she used cholraprp to prep the arm, and then she used OR towels to circle the area, and then she used lidocaine to numb the pt and used the IR needle to get the vein puncture and then she inserted the dialator, but to my surprise, she just kept the dialator in pt's vein and then sent pt to CT scan. So basically she used dialator as PIV for the pt. Pt had CT scan and IV contrast went in no problem. But I was wondering can she do that. because technically, it is a midline placement and I think we need a doctor's order for that, plus microintroducer kit is expensive. the charge to the pt is different than normal PIV. Can anybody share your thoughts about this?????
Chris Cavanaugh
There are a few different

There are a few different issues to examine here: 1)the kit charge to the pt-that would be under your hospital's billing department to issue, hopefully she charged for MST not a PIV, as the procedure codes are different if you are billing to Medicare or Medicaid.

2)The other is the practice issue, which would depend on your state regs, your hospitals policies.  Is she trained to place lines using MST? Competent to do so? What does your hospital policy state about PIVs?  The Introducer and dilator (I am guessing she pulled the dialator out and used the introducer shealth as the "IV") are the same size as a PIV (4FR=20G, 5FR=18G) or maybe a little larger if the introducer/dialator is for a tapered line.  What happened to that line after the scan was completed?  Was a PICC or PIV placed?

3)The third is the fact that this would be considered off lable use of the MST kit.  Some hospitals may state that is OK, some may have concerns with it.  If there was a problem the liablity would be with the clinician who placed it, not the manufacturer. 

Just some thoughts to consider when you discuss this with your hospital management.

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

I would have serious

I would have serious reservations about this practice for additional reasons than what Chris has already provided. I would also think that the dilator was removed leaving the introducer sheath for the injection. These sheaths are a breakaway catheter. This catheter is definitely ***not*** acceptable for high pressure injection in CT.  Because of the breakaway design, this could increase the risk of leakage from the vein and the risk of extravasation and tissue destruction. I would strongly warn against this practice.


Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Robbin George
By design you would not be

By design you would not be able to use the peel away sheath as an IV catheter as there is no way to connect an infusate--One could peel away the sheath and leave a  5-10cm opterator in the vein and attach a short capped extension for IV use--This of course as previously stated is completely off label--However this is basically what we will eventually be able to accomplish with the one piece AST device introduced at the AVA conference known as "The Wand"--Dr. Bierman stated that the device will be configured with various catheter types ranging from IV catheter to Introducer to Midline   

Robbin George RN VA-BC

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