Predicting and Dealing with Difficult Peripheral Iv Access.

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    Predicting and Dealing with Difficult Peripheral Iv Access.

    Nurse: Doctor, this patient is a tough stick. I tried 3 times and I got nothing. Can you help?

    Doctor: Sure! I’ll grab the linear ultrasound vessel finder and get that line in for you, thereby potentially saving this non-critically ill patient from an unnecessary central venous catheter (free pearl #1).

    Nurse: Ok! Do you need the special longer IV angiocatheters?

    Doctor: Why yes, I do. Because I always use the special longer IV angiocaths, as they have a much better chance of not coming out later (free pearl #2).

     

    Then you realize: It has been a little while since you last did an ultrasound guided IV.  So, you check out ultrasoundpodcast.com and watch these brief FOAM videos.

    http://www.ultrasoundpodcast.com/2013/02/microcastiv/

    http://www.ultrasoundpodcast.com/2013/10/ultrasound-guided-peripheral-iv-podcast-give-nurses-teach-providers-foamed/

     

    Now that you’re up to speed,

    1. Name a few predictors of difficult peripheral IV access.

     

    2. When deciding on a vein to use, which features are preferable?

    a) Proximal

    b) Distal

    c) Shallow

    d) Deep

    e) combo of option a + option c

    f) combo of option b + option c

    g) combo of option a + option d

    h) combo of option b + option d

     

    3. What is the likelihood that an ultrasound-guided IV will survive even a few hours if the vein is >1.2cm deep?

    a) 29%

    b) 50%

    c) 74%

    d) 88%

    Question 1: obese, chronically ill, vasculopathy, IV-drug user.

    Question 2: For best results, try shallow and distal (that was option f).

    Question 3: 29%. That’s right. Deeper veins are associated with higher failure rates. Think “Deep trouble!” Don’t feel bad if your line fails unless you had better options. Thus, when choosing a vein, think: location, location, location! (and size too).

     

    Refereneces:

    Shokoohi et al. Ultrasound-Guided Peripheral Intravenous Access Program Is Associated With a Marked Reduction in Central Venous Catheter Use in Noncritically Ill Emergency Department Patients. Annals of Emergency Medicine. 2012.

    Fields et al. The effect of vessel depth, diameter, and location, on ultrasound-guided peripheral intravenous catheter longevity.  American Journal of Emergency Medicine. 2012.

    Emergency Nurses Association: http://www.ena.org/practice-research/research/CPG/Documents/DifficultIVAccessSynopsis.pdf

    www.ultrasoundpodcast.com

     

     

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