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Policies,Clinical,UWHC Clinical,Department Specific,Emergency Department

Ultrasound Guided Peripheral IV Access (14.0)

Ultrasound Guided Peripheral IV Access (14.0) - Policies, Clinical, UWHC Clinical, Department Specific, Emergency Department

14.0

EMERGENCY DEPARTMENT POLICY & PROCEDURE




Effective Date:
Month 3/15/16

ED Policy Manual

Policy #: _14.0_

Original
X Revision

Page 1

Title: Ultrasound Guided Peripheral
IV Access



I. PURPOSE
To establish stable peripheral intravenous (IV) access using ultrasonography (US) guidance in
the Emergency Department (ED) for the patient with difficult peripheral IV access. Ultrasound-
guided IV access is a feasible option for both adult and pediatric populations. (ENA, 2011)

II. POLICY
ED RNs and ED Techs may perform US guided IV placement after successful completion of the
required learning activities and successful demonstration of competency. Demonstration of
competency will include:
A. Completion of class dedicated to initial training sessions that includes didactic information,
simulation, and hands-on practice and
B. Performance of 5 observed US guided IV placements by a nurse or Tech who have
demonstrated competency in this skill, or an Attending ED Physician who has been trained
in US guided peripheral IV therapy at UWHC.

III. EQUIPMENT
A. Gloves and appropriate PPE as necessary
B. IV start kit or equivalent supplies with chlorhexidine sponge (ChloraPrep )
C. IV catheter
D. Bacteriostatic 0.9 % sodium chloride flush syringe
E. IV extension set with needleless connector
F. StatLock or other manufacturer’s securing device
G. Sterile surgical lubricant
H. Portable ultrasound machine
I. Bleach wipes (Cavi-wipes) for cleaning equipment

IV. PROCEDURE
Refer to UWHC Policy 1.23 for consideration of pre-medicating for analgesia
A. Locating and identifying the vein:
1) Position patient and equipment for optimum performance and visualization of
procedure.
2) Place tourniquet.
3) Perform scout scan with US of vasculature of preferred IV site.
4) Identify veins and arteries.
1. Veins are compressible.
2. Arteries are not compressible and are pulsatile (pulsation is increased
with attempt to compress).

EMERGENCY DEPARTMENT POLICY & PROCEDURE




Effective Date:
Month 3/15/16

ED Policy Manual

Policy #: _14.0_

Original
X Revision

Page 2

Title: Ultrasound Guided Peripheral
IV Access


5) Determine the depth of the target vein.
6) Select the appropriate length of IV catheter.
7) Determine the depth of the target vein utilizing depth scale on ultrasound
device (1.16 in. for standard, 1.88 in. for deeper target veins).
8) Release tourniquet.
B. Targeting the identified vein:
1) Clean US probe with bleach wipe (such as Cavi-Wipe)
2) Prepare US probe with thin coat of gel with transparent dressing. Avoid
contamination of the transparent dressing which will contact the patient’s skin.
3) Prep the skin with ChloraPrep
4) Reapply tourniquet.
5) Apply a generous amount of sterile gel to the prepped area.
6) Hold the US probe with the indicator arrow facing the IV starter and the notch on
the left corner of the probe corresponding to the colored dot in the left upper
corner of the view screen.
7) Relocate target vein, verifying non-pulsatile and compressible.
8) Center the indicator arrow on the probe directly over the target vein, and in the
center of the view screen.
9) Hold the probe perpendicular to the vein. (Transverse or Longitudinal view)
10) Place the tip of the IV catheter at the point of the indicator arrow at an angle to
intersect the vein within the plane of the US scan.
11) Confirm target vein is compressible and nonpulsatile.
12) Confirm alignment of vein with the center of the indicator arrow on the probe and
in the center of the view screen.
C. Accessing the vein
1) Pierce the skin with the IV catheter right next to the probe and occasionally slightly
"fanning/tilting" the US probe to keep the needle tip in view on the screen.
2) Observe for movement of tissue and the tip of the IV catheter needle which will
appear as a semi-solid white V with posterior shadowing on the screen.
3) Align the path of the needle to enter the center most superficial area of the vein
wall and observe the needle tip entering the lumen of the vein.
4) Confirm slow venous blood return. If blood return is pulsatile, immediately remove
the needle and apply pressure to the area.
5) Flatten angle of the IV catheter slightly and advance the catheter into the vein.
6) Retract needle while maintaining pressure to the vein distal to the tip of the
catheter; connect the vacutainer sleeve or IV extension set tubing primed with
saline and secure. Release tourniquet.
7) Confirm blood return, easy flush, and absence of swelling or tenderness at site.
8) Secure, dress and label IV site with insertion date and catheter size.

EMERGENCY DEPARTMENT POLICY & PROCEDURE




Effective Date:
Month 3/15/16

ED Policy Manual

Policy #: _14.0_

Original
X Revision

Page 3

Title: Ultrasound Guided Peripheral
IV Access


9) Clean US probe with bleach wipe (such as Cavi-Wipe)

D. Documentation
1) Document use of US for IV placement. Include:
a. Catheter gauge and length, ,
b. Location,
c. Number of attempts,
d. Skin prep,
e. Any local anesthetic, and
f. Site condition
2) Use of ultrasound
E. Cleaning of ultrasound probe. The ultrasound system probes must be cleaned between
patients. To clean the ultrasound system/probe:
1) Turn off the system
2) Use caviwipes or bleach wipes
3) Gently wipe with cavi wipes or bleach wipes over exterior surfaces
4) Remove any unused needles and/or other sharps from equipment
F. IV site monitoring
1) Check frequently for infiltration, inflammation, reactions, and the security of dressings
2) Palpate the site routinely through the dressing for evidence of heat or tenderness
3) Visually inspect for erythema, swelling or drainage around the dressing.
V. UWHC CROSS REFERENCES

A. Nursing Patient Care Policy 1.23, Continuous Peripheral Intravenous Therapy
B. Nursing Practice Guidelines; Prevention of Intravascular Catheter-related infections Nursing
Practice Guidelines. (Available on U-Connect)
C. AFCH/Pediatric Guidelines: Pediatric IV Administration Guidelines (Available on U-Connect)

VI. REFERENCES


EMERGENCY DEPARTMENT POLICY & PROCEDURE




Effective Date:
Month 3/15/16

ED Policy Manual

Policy #: _14.0_

Original
X Revision

Page 4

Title: Ultrasound Guided Peripheral
IV Access


Bauman, M., MD., Braude, D., MD., & Crandall, C., MD. (2009). Ultrasound-guidance vs.
standard technique in difficult vascular access patients by ED technicians. American
Journal of Emergency Medicine, 27, 135-140.

Emergency Nurses Association (2011). Emergency Nursing Resource: Difficult Intravenous
Access Executive Summary. www.ena.org

Joing, S., Strote, S., Caroon, L., Wall, C., Hess, J., Roline, C., Oh, L., Dolan, V., Poutre, R., Carney,
K., Plummer, D., & Reardon, R. (2012). Ultrasound-guided peripheral IV placement. The
New England Journal of Medicine, 366 (25), e38-e40.

Stein, J., George, B., River, G., Hebig, A., McDermott, D. (2009). Ultrasonographically guided
peripheral intravenous cannulation in emergency department patients with difficulty
intravenous access: a randomized trial. Annals of Emergency Medicine. 54(1, 33-39.

White, A., Lopez, F., Stone, P. (2010). Developing and sustaining and ultrasound-guided
peripheral intravenous access program for emergency nurses. Advanced Emergency
Nursing Journal, 32(2), 173-188. doi: 10.1097/TME.obo13e3181dbca70.


VII. REVIEWED BY

ED Clinical Nurse Specialist
ED Clinical Ops Committee
ED Director, Emergency Services
ED Nurse Council
ED Nurse Manager

SIGNED BY

Anne LeGare RN, BSN, CEN Andy Lee MD
Co-Nurse Manager Medical director University ED
Emergency Department Emergency Medicine