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Kelly Tiffany
Peripheral IV Starts Using Ultrasound

Does anyone have a policy and/or procedure on this?  Do you use a sterile sleeve or just hold probe slightly above insertion site?  Are only IV teams doing this or are floor nurses as well?  I didn't find anything on the downloads. 


Kelly Tiffany RN

Vascular Access Resource Nurse

Grand Forks, ND

 In the past few years the

 In the past few years the use of ultrasound for obtaining peripheral IV access has expanded, primarily due to the increase in the number of fluffy patients whose veins are obscured by a layer of adipose tissue, and an increase in the number of chronic patients who have come back to the hospitial so often that the usual sites are used up. 

I believe in many settings that the PICC teams have been pulled into this because desperate nurses in other parts of the facility heard that the PICC nurses had a "vein finder".  That certainly has been the case here.

 Technique varies based on the size and depth of the vein.  For a relatively large vein just below the surface, I often will center the probe over the vein, and press the tip of my pen into the skin (with the point retracted) over the vein to produce a small circle on the skin that will remain visible for anywhere from 5-30 minutes.  I repeat this procedure about 1/2" higher up the arm.  This leaves two dimples which indicate the location and direction of the underlying vein.  I then prep the skin, and do the stick without the use of the ultrasound.

For deeper, smaller veins, I mark the vein as detailed above, then prep the site with Chlorhexidine.  Using a small amount of sterile gel, I place the probe above the insertion site, then do the stick guided by ultrasound, taking care to keep the gel and probe away from my catheter and insertion site.

I have encouraged many of our nurses to use ultrasound, and we have even stationed one of our machines in our urgent care department.  So far I don't think anyone has used it.  Like anything else, the comfort level builds with increased practice, and I don't think most of the nurses need it often enough to develop their skills.

Jerry Bartholomew RN, BSN, CRNI

VA Medical Center, Spokane, WA

Jerry Bartholomew RN, MSN, CRNI

VA Medical Center, Spokane, WA

Kelly Smith
We have also used ultrasound
We have also used ultrasound for peripheral starts on occasion.  We do a chloroprep prep to site, and sterile probe cover and gel. I think an important consideration in doing this though is to consider the depth of the vessel and the length of the catheter.  There can be increased risk of infiltration if the vessel is deep, and then the infiltration can be missed if there is excess tissue in the area ( a common reason to need to use ultrasound).  I don't love the idea of encouraging people who don't routinely use ultrasound to use it due to the fact that they may not consider some of these issues. 

Kelly Smith

PICC Nurse

Boone Hospital Center

Columbia, Missouri

kimberly kay
I'm looking for articles 

I'm looking for articles  on Ultasound insertions of peripheral sites,also the rate of infiltration and basic care and insertion

thank you

Kim Wilkinson

Christiana Care Delaware

rivka livni
We do not have a Policy for

We do not have a Policy for U/S PIV insertion. I get called to do it only after "everyone" failed. I do place the probe above the site, angle it slightly towards the puncture site and clean the skin w/ chloraprep. As mentioned by Kelly Smith, the trick is not to use a vein too deep or else you will get only the tip of the IV catheter in.

Only our PICC RN know how to use the U/S.

kimberly kay
Do you use a long needle?
Do you use a long needle? may I see your policy, also do you see an increase in infiltrations
anna liang
if you do a search in
if you do a search in pubmed, you will find a couple of articles about using ultrasound for PIV, all in the ED setting though.
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