Who among our skilled and talented collective performs MST with U/S to insert peripheral IV's ? And does anyone have a P & P written for it ? Let me know !
I do ultrasound peripherals but I only use Introcan catheters, but this is how I am used to placing my piccs. The trick to doing peripherals with an IV catheter is to "go low and go slow".
Darilyn Cole, RN, CRNI, VA-BC
PICC Team Mercy General Hospital Sacramento, CA
That seems like a lot of work and cost for a PIV when it can be done another way as Darilyn stated. I think our team would go for the PICC at that point.
Please detail what you mean when advising "low and slow" for peripherals with ultrasound. Most of the peripherals I attempt with the US are .5 cm to slightly less than 1 cm. I don't go for the 1cm deep because almost half my catheter is lost in tissue (and that is going in at a high angle). I struggle with this issue. Thanks for any advice you can provide.
I will do PIVs with US when we cannot see or feel a good vein. I will not do it on deeper than 0,5 cm or so, to have enough catheter in the vein.
Do you use sterile gel and stick through it watching it on US or mark where to stick using US, wipe the gel of and stick without the US?
I locate the vein via ultrasound and then remove gel, prep and stick without ultrasound. The initial question confused me with the inquiry about MST. I'm not sure at all how one would insert a PIV using MST. Perhaps that's not what the intended question was meant to be.
I usually will do the same, first locate the vein with US and mark on the skin beside the antecipated stick. Then wipe off the gel, desinfect and place the PIV. I tried sterile gel and placed a PIV through it today and it was also fine. Bit of a hazzle getting rid of the gel though before I could fixate the PIV. Which method do others prefer and why?
Dave, there will be a sesesion at AVA in Sepetember in Washington DC on this topic. I know it doesn't help your situation now though.
Cheryl Kelley RN BSN, VA-BC
In my opinion, the use of US for the insertion of a PIV should be a cautious decicion based on many factors. US is well documented to increase the success of insertion, but there is now a new study identifying outcomes with US-inserted PIVs. Infiltration was found to occur in 47% within 24 hours. So do you really need to go to the trouble and expense of using US for a PIV when some other type of catheter may be more appropriate based on the type and length of therapy? Here is that reference:
1. Dargin J, Rebholz C, Lowenstein R, Mitchell P, Feldman J. Ultrasonography-guided peripheral intravenous catheter survival in ED patients with difficult access. American Journal of Emergency Medicine. 2009.
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
I have a protocol currrently working it's way through the process of approval which I would be happy to share. Unfortunately, I can't figure out how to download to the resources section here. If you contact me directly at [email protected] I'll send it along.