I have seen numerous legal cases where an IV catheter or infiltration/extravasation resulted in nerve injury. It can occur from direct transection or damage to the nerve during venipuncture. It can occur from compression which is causes by a tight dressing or infiltration of fluid. I don't think that most of the US manufacturers make the claim that nerves can be identified with their machines.
The outcome of many cases of nerve damage is chronic regional pain syndrome, Type 1, which leaves the patient with a permanent, life-long pain syndrome. Lynn
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
Most of the ultrasound systems out there are able to visualize nerves - you may want to contact your ultrasound rep. Also, many anesthesia departments are using ultrasound to do regional nerve blocks in surgery. If you know any CRNA's at your hospital, they could probably help, as well.
Nadine Nakazawa, RN, BS, OCN, CRNI, VA-BC
I just testified yesterday on a case dealing with a PICC and median nerve, where the PICC was place through the nerve and left there. I have to say that not only should we be aware of nerve responses such as electric shock, numbness and tingling, but we should also "LOOK" with the ultrasound as part of the assessment. We can learn to identify the median nerve as it is usually pinkie to thumb sized in the brachial bundle. Identification of artery and identification of the median nerve location needs to become part of our normal process of assessment. The nerve looks like a combination of dark small circles with white edges making rings. The nerve is in a circular bundle that sometimes looks like a vein, but it is non-compressible. Look closely at the brachial bundle and identify two veins, one artery and one nerve. The newer ultrasound units such as the Site Rite 5, Sonosite I-Look and 180Plus, the Punctsure and the Medcomp Second Site all have adequate resolution for nerve differentiation.
Boston Scientific has a new program available through the clinical educators on Advanced Ultrasound Assessment, that Kathy King UNC and I authored, that may help.
Nancy Moureau, BSN, CRNI
PICC Excellence, Inc.
Nancy L. Moureau, BSN, CRNI, CPUI, VA-BC
PICC Excellence, Inc