Ultrasound-Guided Peripheral IV

Video Guide: https://www.youtube.com/watch?v=GQGhciB6TvM

 

Relative Contraindications

  • Infection over the site, Hemodialysis in that arm (unless cleared by renal), Severe bleeding diathesis
  • We avoid EJs due to airway compromise if extravasation occurs

 

Pre-procedure considerations

  • Location selection: anuric AKI or ESRD patients – d/w renal
  • Target selection should follow the rule of 2s. Vein must be at least twice the diameter of the catheter being placed, should be no more than 2 inches in depth from the surface of the skin, and should have at least 2 inches of straight (non-tortuous) length

 

Procedure considerations

  • US Probe: Linear
  • Kit: IV start kit; ideally 18G needle
  • Anesthetic use: Consider EMLA
  • 1st choice: basilic vein; 2nd choice: brachial vein
  • Use tourniquet; start at 45° angle
  • Going too shallow could use up too much catheter leaving nothing to put in the vein.
  • Going too steep can cause catheter kinking at the hub where it sticks out of the skin
  • Hold probe close to skin, holding probe far from the end allows too much movement
  • Center the vessel on the ultrasound probe screen prior to sticking
  • Use both short axis and long axis views to ensure correct placement
  • Short axis- Vessel looks round like a target, helps to scout out the tip, and is best for ensuring the vein is entered as opposed to a neighboring artery
  • Long axis- The length of the vessel is viewed. This view is intended for the final few millimeters of catheter advancement into the vein to ensure both bevel and plastic sheath lumen traverse the endothelial layer before threading catheter

 

Post-procedure considerations

  • DON’T FORGET TO REMOVE TOURNIQUET!! Remove before flushing to prevent blowing vein
  • Bleeding complication: if arterial, remove catheter & hold pressure at least 5 mins