Ultrasound-assisted peripheral line placement

Overview

• Ultrasound is a useful adjunct for visualizing vasculature in patients with difficult vascular access

Indications

• Patients with difficult access, multiple unsuccessful attempts
• Commonly required in patients with obesity or history of IVDU

Contraindications

• Ipsilateral radical mastectomy, fistulas
• Overlying cellulitis
• Burns, thrombosis, edema, sclerosis, phlebitis

Equipment Needed

• High frequency ultrasound transducer (7.5 - 10 mHz)
• Probe cover
• IV catheter
• Alcohol Pad / Chlorhexidine
• Tourniquet
• NS Flush
• Tubing, Caps
• Tape, Tegaderm

Procedure

• 3:1:3 rule - look for veins that are a minimum 3 mm in diameter, 1 cm deep (1.5 cm max), 3 mm long (and straight)
• As a general rule the depth of the vein equals the distance from the probe at which you should enter the skin at a 45 degree angle

Basilic veins

Complications

• Hematoma
• Arterial puncture
• Nerve damage
• Bacteremia

Video

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See Also

• Vascular access

References

Liu S. and Zane R. Peripheral Intravenous Access. In : Roberts and Hedges’ Clinical Procedures in Emergency Medicine, Chapter 21, 385-396.e1