We are a small hospital but are looking into potentially using US to place peripheral IV's in the forearm. Is anyone out there doing this? Is it harder to place an IV in the forearm vs above the ac fossa using us?
We are a small hospital but are looking into potentially using US to place peripheral IV's in the forearm. Is anyone out there doing this? Is it harder to place an IV in the forearm vs above the ac fossa using us?
US makes veins easy to locate at all levels of the upper extremity. There is a lengthy learning curve with use of US so don't expect a high level of skill with only a few attempts per person. The issue with any site for US inserted PIV is ensuring that the catheter is long enough to adequately purchase the vein. That means a sufficient length of catheter inside the vein lumen. High levels of insertion success is great, but there are also high rates of infiltration with these catheters and much shorter dwell times. Depth of vein (superficial vs deep veins - a definite anatomical difference) and bariatric patients with excessively large arms (meaning superfical veins are deep within tissue) means at least a 2 inch catheter to ensure at least 50% of the catheter length is in the vein. 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
Our experience shows that with U/S guided PIVs is that there are lower rates of infiltration and longer dwell times. Standard PIV insertion=~2 days vs U/S PIV insertion=>4 days.
8+ years of U/S guided insertions. 200+ per month. 97.3% first attempt success rate. 3 providers with >5 yrs experience per. 740 bed institution.
David Bruce RN
We have been placing about 6-10 ultrasound guided piv's a day since December. US guided piv's are placed in the forearm only, upper arms get powerglides or piccs. We use the 20 gauge 1 3/4" like the ones from the Bard picc kits. If the vein is deeper than 1.5cm we don't use it. I can't provide data yet but am confident that our dwell times are longer and infiltration/extravasations are very low, with the exception of the piv's used for CT power injection. The CT power injected piv's tend to leak or become tender after contrast infusion.
I would comment that a very good stabilizing dressing like Securis or the one everyone calls "shirt and pants" (Centurion?) helps.
There is an excellent youtube video by Sigfried Emme and also Dr. Dawson has an excellent teaching on USG PIVs. Dr. Dawson's is available on the INS website.