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