We have a staff nurse who is placing short pivs in the upper arm using ultrasound. I have witnessed several occassions where this has resulted in terrible infiltrations and hugely swollen arms. I have told his manager this is not best practice, we should not be placing these short piv catheters in the deeper veins of the upper arm, and she wants to see documentation of this. I can not find anywhere where it specifically says you should not do this, just the fact that any time placing access in the upper arm is mentioned, it talks about catheters at least 3 cm long. Any ideas? Am I wrong on this?
You are correct! There are several studies on infiltration and extravasation showing that catheters, even 1.75 to 2 inches long, placed in deep veins of the uppper arm are more prone to extravasation injury. There is not adequate length to purchase the vein so fluid escapes. This will eventually cause a serious complicaiton that will lead to a lawsuit if this practice is not stopped. Also every employer is required to validate competency before someone is turned loose to practice alone on any aspect of patient care. This is a Joint Commission requirement. Lynn
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
Thanks for the quick reply! Do you have any suggested links to studies, so that I can show his manager something?
if you look in the INS Knowlege Center there is an excellent video by Dr Robert Dawson on ultrasound guided piv's. It's "navigating the depths" or something like that. On YouTube there is a video by Sigfried Emme on us guided peripherals also. His video is very good. He also has the recipe and instructions to make your own phantom vein for training. Both discuss angles and vein purchase etc.
We no longer place Short PIV in the Brachial or Balilic area because they will infiltrate.
We however place alot in the cephalic mainly because they are shallow.
we have had good success on deep veins with the Braun 18G/2.5" catheter but we or selective with the pt. who gets this.
we are working on a policy to only allow a PICC nurse or LIP to access the deep veins of the arm.
to answer your question here is a source that Lynn actually gave me last year, note the ER MD's had a 47% infiltration rate within 24hrs.
Here is a study supporting the experiences described in previous messages:
1. Dargin J, Rebholz C, Lowenstein R, Mitchell P, Feldman J. Ultrasonography-guided peripheral intravenous catheter survival in ED patients with difficult access. American Journal of Emergency Medicine. 2010;28(1):338-345.
Basiclic vein in upper arm with a 1.8 inch catheter all placed by MD. 47% infiltrations within 24 hours. We need more outcome data about the catheter, not just insertion success data.