IV Access

In our department, difficult access is one of the most common reasons the ultrasound is pulled into use by all disciplines – physicians, advanced practice providers and nurses. Ultrasound provides a better experience for the patient – we can look to see whether a particular vein even merits an access attempt rather than using an angiocath to see if it is patent. We are more successful in these patients using ultrasound but difficult access remains difficult and ultrasound guided iv access can be either rewarding or frustrating for provider and patient.

INDICATIONS

  • Failed Landmark Technique
  • Known Difficult Access

PREPARATION

  • Print out checklist if needed.
  • Obtain long angiocath, probe cover from Procedure cart
  • Position patient (arm above head if possible)
Positioning for Vascular Access
  • Place Machine on Left, Marker dots on Left
  • Locate Target Vein (Basilic Vein)
  • Prescan / Vein Mapping
  • Check Compressibility
  • Measure Depth

PROCEDURE

  • Out of Plane Needling Approach
  • In Plane Needling Approach
  • Confirmation
    • check long axis
    • disappearing target sign
    • bubble study

CLEAN UP

  • Clean and disinfect probe and machine per policy
  • Return US Machine to Room 11
  • Plug machine into wall power

PITFALLS

  • Using too much pressure
  • Mistaking Artery for Vein
  • Losing track of needle tip
  • Using normal sized angiocath

RESOURCES AND REFERANCES

5 Minute Sono Videos: Part One, Part Two, Part Three