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paul f halvachs
Ultrasound placed IV for CT Pressure Injection

Our radiology nurses have expressed concern over infiltrates and compartmental syndrome with Ultrasound placed IV sites  My thought is that with good blod returns, and longer catheters (we use 1 3/4" 20 g) this is no more a risk than other IV sites.  Any thoughts?  Thanks

Paul Halvachs

Bangor Me.

Timothy L Creamer
Hi Paul, is this a new

Hi Paul, is this a new concern or has an occurrence already happened and they want to reduce the risk of it happening again? I believe if you search "ultrasound guided peripheral IV's" on this site you will find an abundance of information within the Forum. Many clinicians stated guidelines their Team's have adopted to prevent patient injuries i.e. vessel depth, location, etc...  These guidelines suggested are for all PIV's and infusates, not specific to power injected CT contrast.

Timothy L. Creamer, RN

PICC Team Leader, Regional Medical Center Bayonet Point

Clinical Educator, Bard Access Systems

Timothy L. Creamer, RN

Clinical Specialist, Bard Access Systems

paul f halvachs
Concerns are being raised

Concerns are being raised after some nasty infitrates with conventional IV for high pressure CT injection.  They are looking at all aspects and wondering if we can't get a regular IV in, should we just stop there?

 Thanks I did a search under US and found what I needed.

Paul

lynncrni
I have reviewed some legal

I have reviewed some legal cases of bad infiltrations from high pressure contrast injection. Usually these involved multiple venipuncture attemtps, going below a previous puncture site, sites in the volar aspect of the wrist, sites not adequately secured in a joint area and expecting the patient to move from chair to table, not paying attention when the patient complains of pain, not properly assessing the site with a saline injection and blood aspiration before contrast injection. These are all nursing actions that could have prevented the situation. So it seems that a regular PIV can work if the radiology staff knows what they are doing with a PIV site. 

 

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

lynncrni
I share their concerns. We

I share their concerns. We know the US increases the success rate for the venipuncture but it also alters the usual technique. We do not have any data on the clinical outcomes with US-inserted PIVs, although Tim Royer has collected some data of this procedure. I tend to believe that phlebitis and infiltrations may be higher with US inserted PIVs. We definitely a study on this! 

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

momdogz
In our experience, it

In our experience, it definitely is a risk - except if the u/s placed IV is in a vessel that is no deeper than an IV placed by traditional methods. However, if that is true - I vote for the clinicians improving their palpation skills and not relying too much on U/S for PIV cannulation.

I agree with Lynn and Tim - check out the other forum threads on this topic.

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

clhunchusky
Mari, does your facility
Mari, does your facility have a policy for US placed PIVs? Thanks, Cindy Hunchusky,RN,CRNI
momdogz
Hi, Cindy - no, we don't. At

Hi, Cindy - no, we don't. At least not yet.  I have another round of policies that are due for revision coming up in early 2009; I think its a necessary addition.  We do work with the ED (the MDs recently got an U/S to 'help' with their cannulation success, and the ED educator and I had a long discussion about this.  I think she's be very receptive to working on an U/S policy with me.

Do you have one?  I can post what we draft if you're interested. 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

clhunchusky
Mari,   We do not have one

Mari, 

 We do not have one as yet, but definitely see the need for one. We have an ER physician who has been instrumental in teaching ER staff to utilize US for their PIVs avoiding some unneccessary PICC placements. Our PICC team, with management backing, is also trying to push for hospital-wide training of a few select nurses so that they may help cover their units. It is of course a double edged sword as most would acknowledge that deep peripherals have higher incident of infiltration. We know this from our own experience. We don't always know what the patient receives after we leave.

I would be very interested in your draft when it is available since that would be a great starting point for us! Thanks, Cindy/Harris Methodist Hospital/Ft. Worth, TX

rivka livni
I have placed many PIV using

I have placed many PIV using U/S over the past 6 years and found out very quickly that iinserting a peripheral catheter in a vein deeper then 1cm, will most likely result in problems. Now I will place it ONLY if it images 0.75cm ot less.

Since most of the deep peripheral veins are Brachial and Basilic, when they infiltrate I think it takes longer for the patient to "feel" it, thus running into the compartment syndrome when the contrast is 120cc in the tissue over less the a minute, pressing the Brachial artery and so on.

sesymons
I would greatly appreciate
I would greatly appreciate it if anyone who has a policy/guidelines could post it to the downloads section. Thanks
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