Ultrasound-Guided Peripheral Venous Access
Difficult peripheral venous access is commonplace in healthcare. It is disruptive to patient care, and failure to obtain venous access impedes delivery of care in a timely manner. Failure to obtain peripheral access may lead to central line placement and subsequent increased risk to the patient secondary to the many complications of central lines. Ultrasound-guided peripheral access allows clinicians to obtain peripheral access in situations where blind-, landmark-, or palpation-based techniques fail. The proper technique for ultrasound-guided peripheral venous access requires a different skill set than that of traditional intravenous catheter placement and is best performed in the long axis. It can be used to access the antecubital veins, the forearm veins, the saphenous vein or the deep veins of the upper extremity, the basilic vein, and the brachial veins. Utilizing ultrasound guidance for the placement of peripheral venous catheters leads to increased success, fewer needle sticks, fewer complications, and increased patient satisfaction compared to landmark- or palpation-based techniques in patients with difficult venous access.
KeywordsPeripheral access Intravenous access Peripheral catheter IV Peripherally inserted central venous catheter Ultrasound guidance
- 1.Centers for Disease Control. National Hospital Ambulatory Medical Care Survey: 2010 Emergency Department summary tables. 2010. http://www.cdc.gov.ezproxy2.library.arizona.edu/nchs/data/ahcd/nhamcs_emergency/2010_ed_web_tables.pdf. Accessed 27th Jan 2015.
- 3.Sebbane M, Claret PG, Lefebvre S, Mercier G, Rubenovitch J, Jreige R, et al. Predicting peripheral venous access difficulty in the emergency department using body mass index and a clinical evaluation of venous accessibility. J Emerg Med. 2013;44(2):299–305. https://doi.org/10.1016/j.jemermed.2012.07.051.CrossRefPubMedGoogle Scholar
- 8.Liang SY, Marschall J. Update on emerging infections: news from the Centers for Disease Control and Prevention. Vital signs: central line-associated blood stream infections--United States, 2001, 2008, and 2009. Ann Emerg Med. 2011;58(5):447–51. https://doi.org/10.1016/j.annemergmed.2011.07.035.CrossRefPubMedGoogle Scholar
- 15.Shokoohi H, Boniface K, McCarthy M, Khedir Al-tiae T, Sattarian M, Ding R, 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. Ann Emerg Med. 2013;61(2):198–203. https://doi.org/10.1016/j.annemergmed.2012.09.016.CrossRefPubMedGoogle Scholar
- 17.Netter FH. Atlas of human anatomy. 5th ed. Philadelphia: Saunders/Elsevier; 2011.Google Scholar
- 20.Panebianco NL, Fredette JM, Szyld D, Sagalyn EB, Pines JM, Dean AJ. What you see (sonographically) is what you get: vein and patient characteristics associated with successful ultrasound-guided peripheral intravenous placement in patients with difficult access. Acad Emerg Med. 2009;16(12):1298–303. https://doi.org/10.1111/j.1553-2712.2009.00520.x.CrossRefPubMedGoogle Scholar
- 25.Weiner SG, Sarff AR, Esener DE, Shroff SD, Budhram GR, Switkowski KM, et al. Single-operator ultrasound-guided intravenous line placement by emergency nurses reduces the need for physician intervention in patients with difficult-to-establish intravenous access. J Emerg Med. 2013;44(3):653–60. https://doi.org/10.1016/j.jemermed.2012.08.021.CrossRefPubMedGoogle Scholar
- 29.Benkhadra M, Collignon M, Fournel I, Oeuvrard C, Rollin P, Perrin M, et al. Ultrasound guidance allows faster peripheral IV cannulation in children under 3 years of age with difficult venous access: a prospective randomized study. Paediatr Anaesth. 2012;22(5):449–54. https://doi.org/10.1111/j.1460-9592.2012.03830.x.CrossRefPubMedGoogle Scholar
- 32.Doniger SJ, Ishimine P, Fox JC, Kanegaye JT. Randomized controlled trial of ultrasound-guided peripheral intravenous catheter placement versus traditional techniques in difficult-access pediatric patients. Pediatr Emerg Care. 2009;25(3):154–9. https://doi.org/10.1097/PEC.0b013e31819a8946.CrossRefPubMedGoogle Scholar
- 34.Stein J, George B, River G, Hebig A, McDermott D. Ultrasonographically guided peripheral intravenous cannulation in emergency department patients with difficult intravenous access: a randomized trial. Ann Emerg Med. 2009;54(1):33–40. https://doi.org/10.1016/j.annemergmed.2008.07.048.CrossRefPubMedGoogle Scholar