While any visit to the hospital looks different, depending on the patient and their needs, a pretty common procedure done is the placement of an intravenous catheter to provide fluids, medicine, or both. These are so common in fact, that somewhere between 150 to 200 million are placed every year in the United States, according to Presley and Isenberg. Despite the ongoing repetition that medical staff receives, there are often complications with this procedure. Maverick Medical Education knows there are a growing number of uses of point of care ultrasound (POCUS) and the correct placement of these lines is one of them.
Benefits
There are a number of reasons an intravenous catheter may be hard to place. If a patient is overweight, veins are harder to access. Repeated IV drug use also damages veins making this placement difficult. Different chronic medical problems, like hypovolemia, also pose challenges. By using ultrasound guidance, instead of flying blind, a medical professional can perform the procedure correctly the first time. Even if a patient doesn’t have any of these concerns, ultrasound guidance can provide enough ease for the procedure, adding to patient comfort. Correct placement the first time will improve patient comfort as well, reducing stress as medical staff doesn’t have to search for the veins and limiting physical trauma.
How to Use
By familiarizing yourself with how things appear on ultrasound, you will be better served. Bone and the needle tip show up as white, muscle tissue shows up grey, and blood vessels will show up as black circles in cross section. A forearm vein is best, although other veins can be used if needed. When starting out, a transverse view should be used until the needle tip is visualized. The vein and needle should be in line with the centerline of the viewing screen. The probe needs to stay in front of the needle, but the view should be adjusted to slightly proximal. You can adjust as needed with small and smooth movements to keep the patient comfortable. The catheter should not be inserted until the needle enters the vessel wall. You can use the transverse view once again when the catheter is being inserted and secured.
Concerns
Like any procedure, there are concerns. Bruising, small amounts of bleeding, and discomfort are common. These are less likely with the guided access of ultrasound. The first few attempts at performing ultrasound guided catheter placement may be challenging as you learn how to manipulate both tools at the same time. Repetition is important as muscle memory becomes key to proficiency. In non-ultrasound guided placement, nerves could be more frequently touched, multiple tries may be needed, and an eventual central line may be used, a much more invasive procedure.
Intravenous lines with ultrasound guidance are one of the many ways that point of care ultrasound, or POCUS, is being used in multiple fields. Because IVs are used in many fields of practice, there is room for every medical professional to learn this skill as a basic need for their practice, then learn how to apply POCUS to other parts of their care. Our Maverick Medical Education team is ready to train you on this skill so you can begin serving your patients well, contact us today.
