Welcome to RN Ultrasound-Guided Peripheral IV Training
Welcome to the pre-course site for ultrasound-guided peripheral IV access. Below are two narrated lectures that should be viewed prior to and/or after attending the course. Below the lectures, I've included some relevant articles and files for download, including a checklist to be printed out and signed by your supervisor for the ultrasound exams.
USGIV Adult RN Competency Assessment. Click on the button to the left to access the the PDF. You will need to have one of these filled out for EVERY USGIV stick (successful or not). You may be proctored by any ED attending or ED resident. For non-ED RNs, you must be proctored by any U/S-trained attending or fellow. Email me with any questions (firstname.lastname@example.org).
USGIV Adult RN Competency Validation Criteria. Click on the button to the left to access the the PDF. This is simply the list of competency validation criteria for RNs performing US-guided peripheral IVs.
Articles specific to nurse-performed U/S-guided peripheral IV placement.
- SC Advisory Opinion regarding RN-performed U/S-guided peripheral IV. This document states unequivocally that it is within the scope of practice of an RN to use U/S guidance for peripheral IV placement.
- Emergency Nurses Association (ENA) resolution on U/S-guided peripheral IV. This document also states that it is within the scope of practice of an Emergency RN to use U/S guidance for peripheral IV placement.
- 2004 Brannam et al. AEM. EN's had a high success rate (87%) and few complications when performing U/S-guided PIV.
- 2006 Blaivas and Lyon. JEM. EN's taught to perform U/S-guided PIV reported significantly decreases in perceived difficulty of obtaining access "difficult access" patients.
- 2007 Chinnock et al. JEM. Evaluated nurse-performed U/S-guided peripheral IV placement, noting that basilic vein cannulation had a much higher success rate than deep brachial placement.
- 2010 White et al. Adv Emerg Nursing Journal. GREAT review of nurse-performed U/S-guided peripheral IV placement. A must-read.
- 2011 Schoenfeld et al. AJEM. Study showing that ED techs can be taught to successfully place U/S-guided IVs in patients with difficult venous access (78.5% success on 219 attempts). Operator experience correlated closely with success rate.
Articles relevant to U/S-guided peripheral IV placement.
- 1999 Keyes et al. Annals of EM. ED-based study demonstrating that U/S-guided brachial and basilic vein cannulation is safe, rapid, and has a high success rate in ED patients with difficult peripheral intravenous access. Infiltration noted in 8% of patients. First attempt success in 73%.
- 2002 Tagalakis et al. Am J Med. Peripheral vein infusion thrombophlebitis occurs in 25-35% of hospitalized patients with traditional peripheral IV catheters.
- 2004 Sandhu and Sidhu. Br J Anaesth. Basilic and cephalic vein cannulation techniques described.
- 2005 Costantino et al. Annals of EM. U/S-guided peripheral intravenous access is more successful than traditional ‘‘blind’’ techniques (97% vs 33%), requires less time (13min vs 30min), decreases the number of percutaneous punctures (1.7 vs 3.7), and improves patient satisfaction in the subgroup of patients who have difficult intravenous access.
- 2007 Mills et al. Annals of EM. Prospective cohort study of 25 subjects with difficult peripheral IV access. Described approach to placing a 15-cm catheter into the deep brachial or basilic vein. 23 catheters successfully placed. Only 4% complication rate, but wide confidence intervals.
- 2009 Panebianco et al. AEM. U/S-guided peripheral IV placement success not related to patient characteristics or probe orientation. Success associated with a bigger vessel and a shallow depth. Depth > 1.6cm associated with markedly lower success rates, as with vessel diameters < 3mm.
- 2009 Stein et al. Annals of EM. Negative study with regard to U/S-guided peripheral IV. Small study, 59 patients with 2 failed IV attempts were randomized to U/S or non-U/S. No difference in the number of attempts or time to successful cannulation or patient satisfaction. Runs contrary to previous studies. A fair number of the sonographers were less experienced and may have skewed results.
- 2010 Dargin et al. AJEM. Survival of U/S-guided PIV placement. All EP-placed lines, using 2.5 inch 18-gauge catheter. Accessed basilic and deep brachial veins. Overall IV survival rate was 56%. 47% failed within 24 hours (mainly infiltrated). Median survival of 26 hours. Only 1 central line placed as a result of U/S-guided IV failure.
- 2010 Witting et al. JEM. Success rates for U/S-guided PIV higher with bigger veins (> 0.4cm) and veins at a moderate depth (0.3-1.5 cm).
- 2011 Schoenfeld et al. West J Emerg Med. Study demonstrating that patients were highly satisfied with U/S-guided lines.
- 2012 Elia et al. AJEM. Longer IV catheters (12cm) have lower failure rates than short IV catheters (5cm) for deep vein cannulation. Same success rates, but less failure in the long catheters (14%) compared to the short catheters (45%). Cannulation for both involved Seldinger technique. Sterile technique (including sterile gloves) used in the long catheter cannulation.
- 2012 Rickard et al. Lancet. Big trial looking at peripheral IV catheters and scheduled replacement at 72-96 hours. Importantly, there was no increased risk of phlebitis or other serious adverse events in the group with an IV catheter longer than 4 days. Take home point: PIV catheters can be removed as clinically indicated.
- 2012 Shokoohi et al. Annals of EM. U/S-guided peripheral IV placement leads to fewer central lines. The decrease was particularly notable among non critically ill patients (4-5% fewer/month) and discharged patients (7.6% fewer/month). The central venous catheter rate decreased by 80% between 2006 and 2011, the time period in which EM residents and ED techs were trained in U/S-guided PIV placement.