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Ultrasound-Guided Peripheral Access: Part 1

The charge nurse walks over to your workspace and tells you, “The patient you just saw in bed 3 still needs an IV. Our nurses have tried both arms and still aren’t able to get a line. Can you put one in?” You recall the patient’s history of intravenous (IV) drug use and frequent hospitalizations and realize an ultrasound-guided peripheral intravenous (PIV) line will be needed.

You tell your nurse that you’ll be in to help and start to gather your supplies. You grab the ultrasound machine with the linear probe attached, a sterile ultrasound probe cover, an angiocath, a J-loop, single-use sterile gel, a tourniquet, sterile skin prep, a transparent film dressing and a flush.

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 The EM Staple: The Ultrasound-Guided IV

Ultrasound-guided IV placement has been shown to be highly successful, however failure rates can be as high as 45-56%, compared to 19-25% of landmark-placed IVs. Keeping that in mind, here are a few pointers to maximize success and longevity of the IV:

 Tips and Tricks: Best Practices for Ultrasound-Guided IV Placement

These lines are more successful than blind external jugular vein access and compared to central venous catheters they are less invasive and carry less complications.

 Ultrasound guided IV placement. 3/2021

Short video that discusses placing an ultrasound guided peripheral IV. Guides the viewer from preparation to cannulation.

Articles of Interest

Approach to Difficult Vascular Access

Deep veins of the upper arm are generally larger and are the best targets, especially the basilic and cephalic veins.

Common Pitfalls of Ultrasound-Guided Peripheral IV Placement

Placement of an ultrasound-guided peripheral intravenous line (USPIV) is a common and relatively safe procedure. It has been successfully mastered by many members of the health care team, including residents, medical students, nurses, and ED technicians.1–3 In cases of failed access, ultrasound-guided peripheral IV placement is more successful than blind external jugular (EJ) placement and reduces the need for central venous catheters.

Difficult Venous Access in the Emergency Department...

At present is not more reasonable to use PIVs in DIVA patients, even in the ED. More data are necessary but, if confirmed, our study showed that US-LPIVs request the same time of placement of PIVs in DIVA patients with better performance in term of success rate and number of punctures. Moreover, LPIVs mean dwell time is sufficiently long to guarantee a single venous device in most of the patients recruited for the whole period of admission.

How I Teach: Ultrasound-guided Peripheral Venous Access

Ultrasound-guided peripheral intravenous (IV) placement is often required for patients with difficult IV access and is associated with a reduction in central line placement. Despite the importance, there is no standardized technical approach, and there is limited ability to attain mastery through simulation.

Not a Stab in the Dark - Mastering the Ultrasound Guided Peripheral IV

Always use long IV (1.88 inches) catheters or it will pull out of the vessel.

PEM Pearls: Pediatric Ultrasound-Guided Peripheral IV Access

Pediatric patients are not just little adults. Placing peripheral IVs in young patients can be challenging and comes with its own set of challenges. Presented are some basic and advanced tips to maximize success in establishing peripheral IV access in pediatric patients using ultrasonography.

Techniques for Ultrasound-Guided IV Placement

The use of ultrasound-guided IV improves successful cannulation and decreases complications, but cases like this have caused many emergency providers to resent, even fear, this basic procedure.

The Vanishing Target Sign: Confirmation of Intraluminal Needle Position for Ultrasound Guided Vascular Access

When ultrasound is used to guide needle placement into a vessel, two traditional approaches are employed: a short-axis, or out-of-plane, approach, and long-axis, or in-plane, approach.

Ultrasound guided peripheral IV: It’s time to clean up our act

Use a sterile adhesive barrier (such as Tegaderm) or a sterile probe cover. Use sterile gel. Perform the procedure using gloves (no specific recommendation for sterile gloves).

Ultrasound-Guided Peripheral IV Insertion, Placement, and Access Made Easy

Knowing how to properly insert a Peripheral IV under ultrasound guidance can help minimize mechanical complications, help decrease the number of central lines needed, and reduce the time it takes to perform the procedure.