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USGIV venous targets

Looking for something beyond anecdotal and research based on best practice regarding USGIV placement by staff not involved with ED, ICU...ect. VAT are facing challenges with support staff placing/attempting USGIV in upper arms with less than stellar results. Most research Im pulling encourages selecting these upper arm veins to drastically improve success rates but doesnt address the challenges of VAT following up post failure. Ranging from poor imaging due to bruising, infiltration, decreased patient satisfaction, or worst case-inability to place midline/picc and refer to IR for tunneled catheter.  Throw into the mix, limb restricted patients entering into system, can be frustrating. "Common sense" and theorectical logic is not gaining traction. Heels are dug in wanting evidence and research as VAT steer policy to keeping all attempts below antecubital fossa or passing on challenging attempts. Even stepping in to these units has been offered but still in limbo. Look forward to some input.


USG PIVCs in the upper arm

USG PIVCs in the upper arm MUST be long enough to allow for 2/3 of catheter length to reside inside the vein lumen, known as vein purchase. If these other nurses do not have access to catheters that are 2-3 inches, they are highly likely to fail prematurely for various reasons. Research is what produces the standard of practice which can also be considered as best practice. Read now INS SOP on VAscular Visualiation, VAD Planning, Site Selection. YOu will not find anything stating that nurses or any clinician working in XXX dept is not allowed to use US for PIVC insertion. The issue is competency and competency assessment, also addressed in the INS SOP. 


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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

We encountered the same issue

We encountered the same issue at my facility several years ago. To combat this problem, we wrote a policy and developed a competency for USG IV placement, based on the fact that this skill required additional training and knowledge and would be limited to nurses in critical care areas and the emergency department. The policy states that USG PIV are to be placed at or below the level of the AC, with the exception of the cephalic vein. Those who have not completed the training and competency are not allowed to perform the skill. This has greatly reduced upper arm attempts to the basilic and brachials for PIV. 

Khadijah Smith RN

Clear Lake Regional Hospital

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