Ultrasound-Guided

Peripheral IVs
BY ROSALYN CHI
Anatomy
Anatomy on U/S

Basilic vein

Brachial veins

Brachial artery
Equipment

All of your usual equipment for starting IVs:

 Tourniquet, flushes, heplock, chlorhexidine or alcohol pad, tegaderm,
tape
PLUS
High frequency (linear) probe with gel Extra-long peripheral catheter (1.8 - 3in)
Positioning

Arm placement: same as with non-U/S guided PIV

 Shoulder slightly abducted, elbow extended, wrist supinated (possibly on table)

Ultrasound machine
 Opposite side of the bed
 Direct line of sight
 Locating Veins

The ideal vein for U/S guided placement:

• Less than 1cm from surface (though unlikely; hence the U/S!)
• No overlying complicating structure (e.g., arteries or nerves)
• Straight course for several cm (turn probe sideways to get
sagittal view)

REMEMBER: Veins are compressible, arteries are pulsatile!

Maximizing Success

 Superficial veins > deeper veins

 With deeper veins, longer catheters > shorter
catheters
 Veins in the antecubital fossa > veins in the brachial
region
 Pearls and Pitfalls

“I can’t see the vein, cuz it’s too deep!”

 Adjust the depth of your view on the U/S machine

“I can’t hit the vein, cuz it’s too deep!”

 Use a longer angiocath
 Make sure you use a steeper angle

“The screen is too dark/bright!”

 Adjust the gain on the U/S machine

“The anterior wall collapses down all the way to the posterior wall of the vein!”
 If you accidentally puncture both walls and end up outside of the vessel lumen, simply
pull the needle back a tad to pop back into the lumen.

“I have a distal hand IV, but I need an IV in the AC for the CT scan!”
 Place the tourniquet, then inject 50-100cc of saline in the hand IV to plump up the
desired vein
 Pearls and Pitfalls (con’t)

“I always get flashback, but after I pass the catheter, it doesn’t work!”
 Try the “bulls eye technique”
Useful Websites

 EM Curious: Peripheral IV Placement

 http://
www.emcurious.com/blog-1/2014/12/14/ultrasound-leadership-academy-peripheral-iv-placement
 Medscape: Ultrasonography Assisted Peripheral Line Placement
 http://emedicine.medscape.com/article/1433943-overview
 Ultrasound Podcast
 http://www.ultrasoundpodcast.com/2013/10/ultrasound-guided-peripheral-iv-podcast-give-nurses-te
ach-providers-foamed
/
 5 Minute Sono Blog
 http://blog.5minsono.com/diva1/
 http://blog.5minsono.com/diva2/
 http://blog.5minsono.com/diva3/
The End