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Technique for US guided PIV insertion
Could some of you doing US guided PIV insertion describe the details of your technique? Do you use a transverse or longitudinal view? What angle to the skin? Do you put a sterile probe cover on? How long of a catheter do you use? Any site restrictions? Do you hold the probe with one hand and the cath with the other and advance with your 3rd hand? How deep of a vein can you use? Any other things we would need to know? (We have been doing US giuded microintroducer PICCs for years) TIA Tim
I am struggling with

I am struggling with ultrasound guided peripheral IV insertions. We are not yet using sterile sleeves because they are unavailable in my facility though they will be available any day now. I mark the skin with a sterile end cap, stick, then apply the gel on skin proximal to the stick.

My successful sticks have been with one inch catheters but often their length is not adequate. If the vein is deeper than .5 cm, there is not enough catheter to cannulate. We just obtained 1.88 inch BD Insyte 20g, they seem REALLY long.

Sometimes I hold the probe, sometimes I have the nurse that called for the IV hold the probe. Most of the time, they can't keep the probe steady.

Now that I have a minimum level of experience I find that the biggest challenge is to accurately angle the advance of the catheter once I have entered the vein.  





Nancy Rose RN IV Team VA Medical Center Wilmington, DE (800) 461-8262 ext 4830

Nancy Rose 

Nancy, thanks.  Are you

Nancy, thanks.  Are you using a transverse or longitudinal view with the US?  What kind of angle do you use to the skin?


Rob Burr
Tim; I've been successfully


I've been successfully placing PIV's wit US guidance for some time now. I use a sonosite, locate my target using non-sterile gel, then remove gel and prep the area and my probe with Chloraprep. I then switch to sterile gel for the insertion. I do not use a probe cover, and prefer the cross sectional view. I hold the transducer in my left hand, angling the probe to follow my needle tip into the vein.

As for target selection, I begin in the forearms, reserving AC for more short term (CT, outpatient infusion) or desperate situations. If nothing presents itself in either of these areas I will look next to cephalic placement, and if things are really desperate, will look at basilics (but only in the lower 1.3 of upper arm). Brachials are off limits due to high potential for complications should infiltration occur.

My catheter of choice for all but veins within 1cm of the surface (and I rarely see these since I'm the call of last resort), is a 1.88" 20g. I also use Lido for all my starts.

I find my services are being called for more and more often, especially on our larger patients (who are actually the easiest for US starts). It has even begun to reduce the number of PICCs I place (one of our hospitalists occasionally orders "Place PICC if unable to place US guided PIV).

It's a great tool to have. Patients love it. Bedside nurses love it. Low complication rate if you select your sites carefully and know when to say PICC.

Good luck in your practice!

Rob Burr RN

This will be discussed in
This will be discussed in detail at the 2009 AVA Scientific meeting...Sept 15-17, Las Vegas.
We use a Site Rite 6 and use
We use a Site Rite 6 and use the same angle as the needle guide clip on the end of the probe--holding the probe with one hand and sticking with the other.  If using a regular 1 inch Insyte, can only get to veins about 1/2 cm down.  If we save the 1-3/4 inch catheters from our microintroducer kits, we can get to veins about 1 cm down but not much more.
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