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Use of Ultarasound for deep vein access of upper arm.


 I know we have discussed the issues surrounding peripheral access using ultrasaound in the past. I am looking for commentary on the use of peripheral access using deep veins of upper arm.  I have two ED docs asking for 1.88inch 18s and 20s for use in accessing these veins in difficult access patients for peripheral therapies..... You know and I know they define what can go peripherally differently than we do.

 I am concerned with this use of ultrasound and leaving a peripheral catheter in place not a mid or PICC. Infiltration is sure to be the outcome right? What experience if any have others had with this? what is your opinion on this practice?

Thanks in advance for your resonse on this.

Stephen Harris
This is fairly common

This is fairly common practice at our facility in those situations where pt. has had multiple sticks by skilled IV nurses without success. We use the ultrasound(Site Rite 6 which is a great machine by the way)to first access forearm veins and only if necessary go to upper basilic/cephalic. 1.88's are treated no differently than any other peripheral IV here. If pt. has a lot of tissue to penetrate caution must be used for CT power injection as power injectior can back cathter out of vein if enough of it is not in vein. Very few problems otherwise with this.


Stephen Harris CRNI 

I have the same concerns
I have the same concerns about infiltration when the catheter is placed in the basilic vein, which is a deep vein under muscle tissue. This is the same concern as infiltration with a midline catheter. The catheter tip is deep in the tissue; there are larger nerves and arteries that could be damaged from such infiltrations; and more fluid could escape before this would be detected because of the vein depth. We do not have any published data on the clinical outcomes of catheters inserted into peripheral veins using US. So we have no idea about the complication rates with these catheters. Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Heather Nichols
   I guess I have to
   I guess I have to answer your question with a question.  If these patients are having this much difficulty with obtaining a peripheral access, why are you not placing a central access?  Evidently these patients you speak of do not have much to offer in the way of PIV access, so you should be attempting to preserve what they have left, not use up every last vein.  We have a good (at least face to face ;-) working relationship with our doc's here at U of L now, but it has not always been so.  We really worked hard to make them understand why patients need certian types of access by bringing them studies, and letting them know there are more choices than just a triple lume, midline, and picc.  Most of the time, they really do not know that.  And if this PIV is placed in an emergent situation, we are notified after the patient is stablized, to come and place something more substantial.  I wish you luck.  You are in the same aggrevating situation we were in a couple of years ago.  I still get it sometimes.    Heather 
Hi Heather, thanks for the

Hi Heather,

thanks for the advice. It is our ED docs. Unfortunately they have the attitude that since they came from the "big city" hospitals no one knows as much about this as them.... Working on "impressing them with our knowledge and progressive practice.

It will take time but hopefully they will realize the dangers of this practice. 

Jose Delp RN BSN

Clinical coordinator IV Team

Upper Chesapeake Health

Jose Delp RN BSN

CliClinical Nurse Manager IV Team

Upper Chesapeake Health

thanks for this info, we are

thanks for this info, we are having some doctors that think that we can access anything with our u/s..i will pass this along..

Lorrie, RN CRNI, IV Team

Owensboro Medical Health

We often use the 1.88in 20ga

We often use the 1.88in 20ga insyte when inserting peripheral IV's.  We have to be very careful with these because of infiltration.  Often I will have a great blood return and great flow only to find that an hour later it has infiltrated.  I believe this is due to the tissue in the upper arm.  I think any amount of movement can malplace the catheter.  I have personally cut back on using this because of the frequency of the infiltration.


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