US IV Selection

Indications

  • After 3 failed IV attempts, US guided IV placement results in fewer needle sticks, more rapid cannulation and less discomfort than continued to attempts without image guidance.1

Contraindications

  • Avoid arms with2
    • AV fistulas, even if they are nonfunctioning
    • Ipsilateral mastectomy with lymph node dissections
    • DVT
    • Skin tears or open wounds in the area of IV access
  • Patients with CKD 3b (GF < 45)3,4
    • Preferred IV placement in the dorsum of the hand
    • Avoid cannulating the any veins in the upper arm, and avoid cannulating the cephalic vein of the lower arm to preserve AV graft or fistula access in the future
    • Consult with a nephrologist or vascular surgeon for complex patients

Select the catheter size and length

IVs

 



Measure the vessel size and depth in order to select the appropriate IV

screen-shot-2017-02-15-at-4-24-16-pm

US IV Images jpeg

  • The vessel should be at least twice the diameter of the catheter to reduce thrombosis risk
  • ½ of the length of the catheter to reside in the vein to reduce dislodgementIV length

Extra Long 8-12cm 

  • Some catheters are available that are considered “extra long” IVs. If they do not cross the shoulder joint into they are not considered midline catheters
  • This catheter has been proven to last twice as long as a 5cm IV with identical thrombosis rate. 75% of the 12cm catheters were functioning after 3 weeks5
  • Given the higher patency rate of the “extra long” catheters, consider using this catheter in any patient who meets ALL of the following criteria
    • No available vessels in the lower arm
    • Deep arm veins > 1cm
    • Require IV therapy < 14 days

 Next

References

  1. Joing S, Strote S, Caroon L, et al. Ultrasound-guided peripheral IV placement. New England Journal of Medicine 2012;366:e38.
  2. Stone P, Meyer B, Aucoin J, et al. Ultrasound-guided peripheral IV access: Guidelines for practice.
  3. Simonov M, Pittiruti M, Rickard CM, Chopra V. Navigating venous access: A guide for hospitalists. Journal of hospital medicine 2015.
  4. Chopra V, Flanders SA, Saint S, et al. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a Multispecialty Panel Using the RAND/UCLA Appropriateness Method. Annals of internal medicine 2015;163:S1-S40.
  5. Elia F, Ferrari G, Molino P, et al. Standard-length catheters vs long catheters in ultrasound-guided peripheral vein cannulation. The American journal of emergency medicine 2012;30:712-6.