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pattonlg
Ultrasound Guided IV insertions and increased risk of UEDVT and Infiltrations

Are any of you aware of any studies conducted with regards to U/S Guided IV insertions and increase DVTs or infiltrations.

Do any of you use U/S in order to place IVs? Have you noticed a trend in increased complications with ultrasound vs other methods? Any response would be greatly appreciated.

RoseFeltner
I did notice increased rates

I did notice increased rates of infiltration when I started PIVs with U/S.  I would have brisk blood return and PIV flushed easily without swelling then bedside nurses calling within a couple of hours due to the PIV infiltrating. I came to the assumption that it was probably due to my PIV catheter being just inside the vein and thus with patient mobility it was sliding out of the vein easier.  I have found 22g ONC that are 1 3/4in long, since starting to use these this problem has disappeared.

Hope this helps,

Rose

Rose Feltner RN, BSN, CRNI
Speciality Practice Nurse
Vascular Access Team
Indiana University Hospital Bloomington
[email protected]

Robbin George
What is the Brand name of
What is the Brand name of the 22g 1-3/4in IV catheter?--Thank you 

Robbin George RN VA-BC

RoseFeltner
BBraun, The reference number

BBraun, The reference number is 4252520-02.

Hope this helps.

 

Rose

Rose Feltner RN, BSN, CRNI
Speciality Practice Nurse
Vascular Access Team
Indiana University Hospital Bloomington
[email protected]

monicasorg
I know of no studies
I know of no studies regarding this issue, however it would be a good one to conduct.  I worked at a hospital where we used the ultrasound to place difficult pivs.  At first when the floor nurses called for help I would use the ultrasound automatically.  I guess because it was easy and new to me.  Then my nursing brain engaged.  Use my skills and if that didn't work, then use the ultrasound.  I will say that the deeper the vein, the more infiltrations I saw, and because the vein was deeper the infiltration didn't necessarily show itself for a while.  I think part of it was the angle I was using and perhaps the length of the catheter.  At a steeper angle I think the catheter kinked.  At a more angled approach less of the catheter went into the deeper veins and probably dislodged.  I became less inclined to place the deeper pivs.  I don't think our team as a whole had increased infiltrations with pivs placed manually vs with ultrasound as long as they were placed in the more shallow veins.  Heather, Leigh Ann and Brian, hop in here.  This was just my experience.  Monica
lynncrni
I have always thought part

I have always thought part of the problem with increased phlebitis and/or infiltrations following US insertion of PIV is related to the technique required. Skin traction to anchor the vein is one of the most important methods to cause the catheter to advance smoothly into the straight vein and avoid contact with the vein wall. One hand to hold the probe and one hand to hold the catheter does not allow one hand to hold skin traction. What clever ideas have you used to overcome this issue? Using 2 people, or others? I know we are talking about veins that are deeper in subcutaneous tissue, but these are still not deep veins in the same sense as anatomical descriptions. When I say a deep vein, I am referring to those that are located under the muscle. So my understanding from this discussion is that you are using superficial veins that are deeper in subcutaneous tissue due to obesity or other problems. Please correct me if you are actually using deep veins under the muscle. Thanks, Lynn

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

monicasorg
You are correct.  I am

You are correct.  I am referring to the veins deeper in the subcutaneous tissue, not those under the muscle.  I am right handed.  I held the ultrasound probe in my left hand and traction distal to the site with the flattened pinky of my right hand (easier to show that to describe) while accessing using the more angled technique that I described in my last note. This approach requires that the probe be moved a bit proximal to the intended insertion site so that the image shows up where you expect the needle to enter the vein. With this technique it seemed to enter the vein at an angle similar to starting the piv without ultrasound assistance.  This worked best for me, however it still seems logical that using a vein deeper in the subcutaneous tissue holds more potential for complications than the more superficial ones that are generally used not requiring ultrasound assistance.  

Monica

DonnaS
Our institution is the proud
Our institution is the proud owner of a Veinviewer machine by Lumintex.  It is compeltely hands free and the success rate on those patients that are impossible is amazing.  The other great thing about it is that when I have accessed the vein I am able to visualize if the vein is blown or leaking as well as track the saline flush up the vein.  This assures me that I am in and the fluids are going were they are suppose to.  Just this afternoon I started an IV on a 57 day old, dehydrate infant.  I was able to clearly visualize the vein and pop it right in.
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