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Policies,Clinical,UWHC Clinical,Department Specific,Nursing Patient Care,Cardiovascular and Infusion

Ultrasound Guided Peripheral IV Placement (Adult & Pediatric) (1.53 AP)

Ultrasound Guided Peripheral IV Placement (Adult & Pediatric) (1.53 AP) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Cardiovascular and Infusion

1.53 AP

NURSING PATIENT CARE POLICY & PROCEDURE





Effective Date:
February 19, 2016

Administrative Manual
Nursing Manual (Red)
Other _______________

Policy #: 1.53AP

Original
Revision

Page
1
of 4

Title: Ultrasound Guided Peripheral IV
Placement (Adult & Pediatric)

I. PURPOSE

To ensure appropriate use of portable ultrasound (US) machine when placing a
peripheral intravenous (PIV) by a Registered Nurse (RN).

II. POLICY

A. Only trained RNs who have demonstrated competency on the use of ultrasound
for placement of a peripheral IV may utilize US for placement of a PIV.
B. Refer to Nursing Patient Care Policy 1.23AP, Continuous Peripheral Intravenous
Therapy (Adult & Pediatric), for changing PIV.
C. Perform hand hygiene according to UWHC Hospital Administrative Policy 13.08,
Hand Hygiene.

III. EQUIPMENT

A. Portable US machine and non-sterile gel
B. 3 mL antiseptic prep (2% CHG/70% isopropyl alcohol) (Central Service [CS]
Item Number 4002911)
C. Transparent dressings (6x7 cm) (CS Item Number 2200117)
D. IV catheter securement device (Statlock) (CS Item Number 4006582)
E. Appropriate IV safety catheter for selected target vessel
F. Sterile US gel, 20 grams (CS Item Number 2201677)
G. 10 mL 0.9% Sodium Chloride saline syringe flush
H. Local anesthetic
I. TB syringe
J. IV start kit
K. Extension set with needleless connector
L. Tourniquet

IV. PROCEDURE

A. Site Selection
1. For site selection, refer to Nursing Patient Care Policy 1.23AP,
Continuous Peripheral Intravenous Therapy.
2. Depress vein with US to differentiate veins from arteries. Veins will stay

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depressed. Arteries will pulsate due to blood being forced through the
depression.
3. When appropriate vessel is selected, release tourniquet.
4. If no appropriate vessel is identified, discuss consideration of other types
of access for the patient with the medical team.
B. For site preparation and premedication for analgesia, refer to Nursing Patient Care
Policy 1.23AP, Continuous Peripheral Intravenous Therapy.
C. Medicate per Delegation Protocol 29, Analgesic Ordering Prior to Needle
Insertion, Adult/Pediatric, Inpatient/Ambulatory.
D. Probe prep
1. Clean probe head with approved cleaner.
2. Apply dime-sized amount of sterile gel to probe.
3. Apply sterile 6x7 cm transparent dressing over probe and gel to maintain
probe sterility during procedure.
E. Venipuncture/Insertion of Catheter
1. Catheter selection should be based on depth of the vein using depth scale
on right side of ultrasound machine. At least half of the catheter length
should reside in the vein at final positioning. Reapply tourniquet.
2. Perform hand hygiene according to UWHC Hospital Administrative
Policy 13.08, Hand Hygiene.
3. Apply a small amount of sterile gel above selected insertion site.
4. Position the probe and locate vein.
5. Using center mark of transducer aligned with vessel as guide, advance
catheter into target vessel while watching/guiding tip progress with US.
Once a blood return is visualized, lower angle of catheter and slide
catheter off stylet into vessel to hub of catheter. Activate safety device.
6. Set aside transducer, and release tourniquet.
7. Flush catheter per Flushing/Locking of Venous Access Devices-
Pediatric/Adult- Inpatient/Ambulatory Clinical Practice Guideline.
8. Wipe gel from around catheter using sterile 2x2s.
F. Catheter Securement and Dressing
1. Apply StatLock® and secure PIV according to Nursing Patient Care
Policy 1.23AP, Continuous Peripheral Intravenous Therapy .
G. Documentation
1. Document the following in the patient’s clinical record:
a. IV site location and preparation
b. Gauge of catheter
c. Number of attempts
d. Type of dressing
e. Analgesic agent
2. Use of Ultrasound

V. CLEANING PROCEDURES

A. The ultrasound system probes must be cleaned between patients. To clean the
ultrasound system/probe:

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1. Turn off the system.
2. Use caviwipes or bleach wipes.
3. Gently wipe with caviwipes or bleach wipes over exterior surfaces.

VI. UWHC CROSS REFERENCES

A. Delegation Protocol 29, Analgesic Ordering Prior to Needle Insertion –
Adult/Pediatric – Inpatient/Ambulatory
B. Flushing/Locking of Venous Access Devices- Pediatric/Adult-
Inpatient/Ambulatory Clinical Practice Guideline.
C. UWHC Hospital Administrative Policy 13.08, Hand Hygiene
D. Nursing and Patient Care Policy 1.23AP, Continuous Peripheral Intravenous
Therapy (Adult & Pediatric)

VII. REFERENCES

A. Adhikari, S., Blaivas, M., Morrison, D., & Lander, L. (2010). Comparison of
infection rates among ultrasound-guided versus traditionally placed peripheral
intravenous lines. American Institute of Ultrasound in Medicine: Ultrasound Med,
29, 741-747.
B. Bauman, M., Braude, D., & Crandall, C. (2009). Ultrasound-guidance vs.
standard technique in difficult vascular access patients by ED technicians.
American Journal of Emergency Medicine, 27(2), 135-40.
C. Fields, M. J., Dean, A. J., Todman, R. W., Au, A. K., Anderson, K. L., Ku, B. S.,
Pines, J. M., & et al. (2012). The effect of vessel depth, diameter, and location on
ultrasound-guided peripheral intravenous catheter longevity. The American
Journal of Emergency Medicine, 30(7), 1134-1140.
D. Goldstein, J. (2006). Ultrasound-guided peripheral venous access. Israeli Journal
of Emergency Medicine, 6(4), 46-52.
E. Gregg, S.C., & et al. (2009). Ultrasound-guided peripheral intravenous access in
the intensive care unit. Journal of Critical Care, 25(3), 514-19.
F. Hadaway, L. (2009). Ultrasound techniques for peripheral catheter insertion.
Lynn Hadaway Associates, Inc. Infusion Therapy Performance Consulting.
G. Heinricks, J., & et al. (2012). Ultrasound-guided Peripheral Intravenous
Cannulation (PIVC) of Children and Adults: A Systematic Review and Meta-
analysis.
H. Maiocco, G., Coole, C., & Johnson, L. A. (2011). Use of ultrasound guidance for
peripheral intravenous placement in difficult-to-access patients: advancing
practice with evidence. Journal of Nursing Care and Quality, 27(1), 51-55.
I. Spiro, M.D. (2011). No reason not to know ultrasound guidance. Emergency
Nurses Association. Official Magazine of the Emergency Nurses Association.
J. Wang, R., Snoey, E., & Frazee, B. (2005). Ultrasound-guided deep brachial and
basilic vein cannulation in the emergency department. The California Journal of
Emergency Medicine, 1(2), 38-40.



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VIII. WRITTEN BY

Nursing Education Specialist, Nursing Education and Development

IX. REVIEWED BY

Nurse Manager, Venous Access Team
Nursing Patient Care Policy and Procedure Committee, February 2016

SIGNED BY

Beth Houlahan, DNP, RN, CENP
Senior Vice President Patient Care Services, Chief Nursing Officer