Ultrasound-Guided Peripheral IV Insertion By Nurses

Purpose:

To outline the process for insertion of peripheral intravenous line (PIVs), obtaining arterial blood samples from the radial artery, and assessing fetal heart rate using ultrasonography guidance by RNs in the Emergency Department.

Policy:

RNs may perform ultrasonography (US) after completion of the required learning activities and successful demonstration of competency.

Procedure for PIV:

1. Equipment for Insertion

  • Tourniquet
  • Tape
  • Tegaderm dressing (2)
  • Gloves
  • Chloroprep swabs
  • IV catheter (1.16 in. for standard, 1.75 in. and 2.5 in. for deeper veins)
  • Saline flush syringe
  • IV extension set tubing
  • Non-sterile U/S gel
  • Surgilube
  • Portable ultrasound machine

2. Insertion

1 / Gather the appropriate IV supplies (including tourniquet, angiocath, Tegaderm, U/S gel, Surgilube, IV cap, flush, etc.)
2 / Verify the order for ultrasound guided peripheral IV access.
3 / Identify the patient by first & last name and DOB.
4 / Identify yourself and the reason for the procedure giving the patient an opportunity to ask questions.
5 / Perform hand hygiene and don gloves.
6 / Position the ultrasound for ease of viewing the screen.
7 / Apply the tourniquet and place ultrasound gel on intended area.
8 / Assess and identify an appropriate vein (forearm or antecubital, cephalic, or basilic; deep brachial only after approval by the attending MD), appropriate vein depth (<1.5cm), and differentiate from the artery. Use compression technique and color flow to differentiate vein versus artery.
9 / Remove the tourniquet and clean gel off of the patient's arm.
10 / Reapply the tourniquet.
11 / Clean the area with chloraprep.
12 / Place a Tegaderm on the probe.
13 / Place sterile gel (Surgilube) on the Tegaderm covering the ultrasound probe or directly on the clean skin surface of the patient.
14 / Place ultrasound probe on appropriate IV site maintaining sterility of site.
15 / Proceed with venipuncture under dynamic US guidance
16 / Confirm angiocath placement in the corresponding vein based on blood return in the collection chamber
17 / Advance the angiocath needle into the vess another 0.5 cm. Advance the catheter over the needle into the vein.
18 / Confirm catheter placement in a longitudinal plane.
19 / Withdraw blood from the catheter to confirm placement (and perform blood collections as needed).
20 / Secure the IV.
21 / Release the tourniquet and then flush the catheter to confirm placement.
22 / Write the date, catheter length/gauge, and initials on the tape over the IV dressing.
23 / Dispose of needle in sharps container.
24 / Document IV placement in medical record.

3. Reportable Conditions

  • Red streaks/phlebitis proximal to insertion site.
  • Cyanotic extremity distal to insertion site.
  • Blistering.
  • Medication extravasation or infiltration of the PIV.
  • Redness, tenderness, heat or drainage at site.