- 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
- Avoid arms with2
- AV fistulas, even if they are nonfunctioning
- Ipsilateral mastectomy with lymph node dissections
- 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
- 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 dislodgement
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
- Joing S, Strote S, Caroon L, et al. Ultrasound-guided peripheral IV placement. New England Journal of Medicine 2012;366:e38.
- Stone P, Meyer B, Aucoin J, et al. Ultrasound-guided peripheral IV access: Guidelines for practice.
- Simonov M, Pittiruti M, Rickard CM, Chopra V. Navigating venous access: A guide for hospitalists. Journal of hospital medicine 2015.
- 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.
- 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.