I have used ultrasound for PIV sticks "when needed" for about 7 years now. I do not use it unless it is a must. It took me about a year to perfect my technique. I use a Site rite 6 but started out with a site rite 2. We also have a sonosite I-look. Ultrasound used depends on personal preference in my opinion. It is what you can get used to. I myself do not have a problem using any of them, including the huge GE u/s used in the ultrasound dept when I have to go down there. I agree that it has a big learning curve, and it is hard to teach others. You need to have an aptitude for it to begin with it seems, but if you are dedicated, anyone can learn as long as you practice- a lot! I do not agree with the 1cm deep limit. I would not go more than 2 usually, but it really depends on the angle you place on your needle. Needle guides are NOT helpful when placing PIV sites with u/s. You MUST judge your angle of insertion by your distance of the vein. This is a very debatable topic, but until a reliable answer is found for these problematic patients, it is going to be done, and these particular patiests appreciate it. We do a full patient assessment on any patient we get called for access on, so we place the correct access in the beginning, but there are always going to be those patients that need a PIV "for a short time", and a PICC or central line is just to much of a risk when the risk/benefit calculation is done. I am currently writing a Policy and Procedure on PIV's with ultrasound. I will post it when I complete it. Good luck, and remember to adjust those angles when you stick!
Have you completed your P&P for ultrasound guided PIVs? I am currently working on this for our hospital and am drowning in info but no actual consistant practice guidelines. Any tips you can offer would be greatly appreciated!
Needle guide benefits include optimizing needle tip visualization. By visually verifying needle tip in center of vessel then trauma to intima can be avoided, 1st attempt success rates may increase, and patient satisfaction most likely will improve. I have observed needle guides used and not used for PIV's, depending on vein depths and available gauge size of needle guides. Commonly stocked size may be 21g needle guide versus the 20g/1.75" catheter included in kit.
Timothy L. Creamer, RN
Clinical specialist, Bard Access Systems
Timothy L. Creamer RN, CRNI
Clinical Specialist, Bard Access Systems
Does your facilty have a P&P for use of ultrasound for PIVs? I am trying to get one in place and would appreciate any tips. Sounds like your group has great experience!
Nancy Rose RN IV Team VA Medical Center Wilmington, DE (800) 461-8262 ext 4830
Any tips about angle of needle insertion would be greatly appreciated. My angle isn't working.
Those of you that do US IVs,
Is there a limitation on the areas of the arm? We are finding them placed in the upper arm and not lasting long. This is probably due to not having a long enough catheter.
I would like to have them limit their sticks to AC or lower arms. What do you think?
I agree with Gwen. I think the deeper veins in the upper arm (Basilic, Acessory Brachials) should be used as a last resort for starting PIV using US.We need to maintain patency & healthiness of these veins for PICC placement. I've seen some of the Sites infitrate easily . Then you would not be able to use these veins for infusion at that time.I would try using the veins in the lower arm or the ac area first. And If I had to I would look at the cephalic vein in the upper arm it is the most superficial of the deep veins in the upper arm.I try to perserve the deep veins in the upper arm and use them only in emergencies. Thanks, Vickey
Candee Eisenhart BSN, CRNI, VA-BC
If you visit the site for The-Wand.com you will see that a 3 inch power injectable version is
forthcoming--Seems to me that this devise might meet the needs of those patients with
limited peripheral access we encounter in the ED and other short term situations
Robbin George RN
Vascular Access Resource Department
Robbin George RN VA-BC
I went back and found this thread from more than 6 months ago--The question about competaency and P&P was never answered--Surely of all the clinicians that are practicing the technique of PIV insertion with US someone has developed a guidance document--Please share it with the IV-Therapy.net community--Thank you
SONOSITE DOPPLER COMPETENCY
EVALUATION MECHANISM: ¨ Simulation ¨ Clinical Performance
1. Uses two (2) identifiers to verify patient identification
2. Explains procedure to patient/family/significant other.
3. Identifies and collects supplies
4. Washes hands and dons gloves
5. Obtains image – locates vessels
6. Confirms vein by:
a. manual compression
b. appearance of valves
c. phasic, non-pulsatile flow
7. Prepare sterile transducer field
8. Choose lateral or transverse approach:
Lateral: keep needle within scan plane
Transverse: image the vessel to find the depth and use triangulation to
estimate needle path.
Look for “tenting” of near wall as needle approaches
NAME: ___________________________________________ EVALUATOR: ______________________________
DATE: _______________________ PASSED _________ REQUIRES REMEDIATION
ULTRASOUND GUIDED VENOUS ACCESS – BASIC KNOWLEDGE
By PICC Nurse