What do you think…

Q:  We have a 24/7  vascular access team, yet we find that an ultrasound machine  in a medical floor is used for PIV insertion by untrained nurses and residents. The machine is there for other purposes but is being used for hard IV sticks.

A:  There is increasing evidence to show the use of ultrasound or vein finding technology increase success rates particularly in patients with difficult veins to access. The INS standards recommend the nurse to consider using visualization technologies that aid in vein identification and selection (S33). The use of  ultrasound allow the identification of peripheral vessels and guide the insertion procedure.  There are reports that ultrasound guided peripheral IV cannulation is successful more than 90% of cases. In addition, it improves patient satisfaction and safety with fewer sticks.

I think anyone who reads this post will agree that healthcare providers using these technology must be properly trained and/or competency checked off. Just because there is an ultrasound machine available on a medical unit doesn’t entitle anyone to use it without proper training. The operator should be very familiar with the ultrasound machine, the type of transducers used, how to improve ultrasound gain and how to control its outcome. The operator should be especially knowledgeable of the sonographic artefacts that can mislead him/her.

In addition, your facility/institution/organization should have policies and procedures related to the training. competencies and use of ultrasound technology. Check out what your policy is and hope you have one. In some, the use of utlrasound for PIV insertion is limited to vascular access teams and the ED. In your case, with a 24/7 vascular access team, the medical floor should take advantage of your service and expertise.

Thanks for your question. I wish you the best.

References:

  1. Infusion Nurses Society 2011 Standards of Practice.
  2.  Abu-Zidan Fikri M Point-of-care ultrasound in critically ill patients: Where do we stand?J Emerg Trauma Shock. 2012 Jan-Mar; 5(1): 70–71.
  3. Elia F, Ferrari G, et al Standard-length catheters vs long catheters inultrasound-guided peripheral vein cannulation. American Journal of Emergency Medicine (2012) 30, 712–716

 

 

 

 

 

 

4 Comments

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4 responses to “What do you think…

  1. As a PICC/ Vascular access nurse, we have come across this – and I agree, it should only be utilized by trained/ competency checked personnel when it is in their scope of practice. When others try without the training/ competency, I see more damage to the patient’s veins as well as the veins that should be preserved for central access (PICC’s) being used up. Clinicians using the ultrasound should be assessing the appropriate site as well as the appropriate vascular access device. Often untrained clinicians go for the ‘easy’ bigger veins in the joints or upper arms, too many times they infiltrate, and then that arm is unusable for more long term or any vascular access. There is also the concern of infection from improper training for ultrasound guided PIV placement. So, train/ get the competency – and then all are protected – patient and clinician alike. :)

  2. Sutheera Tretriluxana

    I agree that the trained nurses should use the ultrasound to screen for potential decent veins only from antecubital area down to the wrist, not the upper arm (reserved for midline, extended dwelling catheter or PICC) before inserting peripheral IV catheter. Competency per the hospital policy is very essential.

  3. Ultrasonography performed by well trained personnel is not only very useful for peripheral vein cannulation but also for AV fistula or graft cannulation, especially in relatively new accesses. Good use of this technology will reduce the damage inflicted to the access by the old visual/palpation cannulation.