Ultrasound Guided Peripheral IV Precepted Practice PDF

CHRISTUS St. Patrick Hospital 1 Ultrasound Guided Peripheral IV Precepted Practice Name: ____________________ Unit _______ Date: _________ Completion Date of Ultrasound-Guided Peripheral IV Module: __________ E...

CHRISTUS St. Patrick Hospital 1 Ultrasound Guided Peripheral IV Precepted Practice Name: ____________________ Unit _______ Date: _________ Completion Date of Ultrasound-Guided Peripheral IV Module: __________ EVALULATOR________________ EXAMINEE___________________ SIGNATURE___________________ SIGNATURE__________________ # Cases as Precepted on UGA-PIV insertion (3): _____ PASS____ FAIL____ Precepted Practice Criteria Pt 1 Pt 2 Pt 3 PRE-PROCEDURE STEPS 1. Check care plan, treating clinician orders, and facility protocols for ultrasound guided IV insertion, if available. 2. Review medical history/medical record for: o Indications for peripheral IV placement via ultrasound guidance o Anatomical issues at proposed insertion site o History of coagulopathy o Medication use, such as blood thinners, including NSAIDs, which could affect blood clotting and increase risk of bleeding o Labs/other diagnostic test results o Allergies 1. Introduce yourself to patient/family. 2. Identify patient using at least 2 unique identifiers 3. Identify and address any special communication needs patient/family may have. 4. Identify and accommodate, if possible, any specific cultural and religious beliefs that may enhance care. 5. Ask patient if they would prefer a clinician of a certain gender if procedure involves steps that possibly compromise dignity/privacy. 6. Provide privacy for patient. 1. Explain procedure. Verify completion of informed consent documents, if  CHRISTUS St. Patrick Hospital 2 Ultrasound Guided Peripheral IV Precepted Practice appropriate. 2. Verify supplies are in good working order and review manufacturer instructions for use. PROCEDURE STEPS 1. Use standard aseptic non-touch technique throughout procedure to prevent cross-contamination and lower risk for catheter-associated infection. 2. Check for prior needle sticks at proposed insertion site and assess patient for relative contraindications to IV insertion, which may indicate an alternative IV site or method of venous access is needed 3. Position patient. a. Place patient in supine or sitting position. b. Raise or lower height of patient and monitor to avoid having to bend or turn your head to view images. c. Position patient in lying or seated position with their arm flat on horizontal surface. d. Rotate patient’s arm to provide access to proposed insertion site. 4. Prepare ultrasound probe and transducer. a. Clean transducer with facility-approved solution. b. Place nonsterile ultrasound gel on ultrasound probe. c. Place sterile transparent cover or sheath over ultrasound probe. d. Place sterile ultrasound gel on ultrasound probe sheath. e. Adjust settings on transducer so blood vessels appear in center of screen and are black. 5. Administer or apply site anesthetic as ordered. 6. Place tourniquet on patient’s arm proximal to insertion site. 7. Choose transverse (short axis) or longitudinal (long axis) view to localize and visualize selected vein. Note imaging vein from 2 directions may inform about patient’s local anatomy, thus decreasing risk of injury to surrounding structures. Transverse Technique 1. Scan arm by moving transducer up/down chosen insertion site to locate target vein. 2. Confirm ultrasound image lines with same side of transducer (such as, left side of image and left side of transducer).  CHRISTUS St. Patrick Hospital 3 Ultrasound Guided Peripheral IV Precepted Practice 3. Identify vein for cannulation and determine depth of vein. a. Hold IV catheter needle with dominant hand at 45° angle to skin. Hold ultrasound probe with nondominant hand. b. Insert needle and advance in direction of vein. Always advance ultrasound probe simultaneously as IV catheter is advanced. c. If unable to view needle tip, drag or fan transducer probe gently over site, or bounce needle slightly while looking for movement of adjacent soft tissue and needle tip on transducer screen. d. Continue to advance needle into vein. Avoid passing needle through posterior vessel wall and tilt transducer in direction needle is traveling. e. Stop advancing catheter if resistance is met, as this indicates improper positioning of catheter. f. Assess for blood return which indicates needle has entered vein. g. Decrease angle of needle, and advance needle 1-2 cm h. Secure needle with your nondominant hand and advance catheter over needle into vein 4. Remove tourniquet. 5. Secure catheter per facility protocol. 6. Flush catheter with normal saline. Longitudinal Technique a. Scan arm by moving transducer up/down chosen insertion site to locate target vein using transverse approach. b. Rotate transducer 90° so that probe’s long axis is parallel to course of vein, which allows for direct observation of needle penetration into vein and passage of guidewire. c. Identify side of image representing distal vein. d. Secure transducer on patient with nondominant hand. e. Swab skin at site with antiseptic solution using ANTT. f. Instruct patient to keep arm extremely still. g. Hold needle at 30° angle with dominant hand. Insert needle at center of long axis of transducer. Advance needle within ultrasound plane. h. If vein but not needle is in view, back up and redirect needle as needed, and advance needle only if tip is visible. i. Use quick forward movement to pierce vein. Avoid vein compression in response to needle.  CHRISTUS St. Patrick Hospital 4 Ultrasound Guided Peripheral IV Precepted Practice j. Confirm needle and catheter placement using transducer. k. Visually identify needle tip inside vein. l. Use forward motion to advance catheter over needle and into vein. m. Visualize catheter advancing forward and off of needle into vein. 7. Verify blood return by viewing blood in catheter POST-PROCEDURE STEPS 8. Label images obtained during insertion with patient/facility-identifying information, such as pre-procedure venous patency, surrounding anatomy, needle tip placement, and post-procedure flush. 9. Monitor and reassess IV insertion site per facility protocol. Assess for: a. Catheter position/migration and catheter patency/occlusion b. Limb symmetry, particularly due to infection, phlebitis, infiltration and extravasation c. Skin discoloration (blanching, erythema) d. Disruption of sensation (pain, tenderness, numbness, tingling) e. Edema/localized swelling f. Increase in skin/basal body temperature g. Induration with palpable cord h. Pressure sores and other signs of skin integrity disruption/infection 10. Replace and/or discontinue IV catheter infusion set per facility protocol, treating clinician orders, or immediately upon suspected contamination. 11. Follow standard post procedure steps, as appropriate. * To be turned in to Unit Manager upon completion *  CHRISTUS St. Patrick Hospital 5 Ultrasound Guided Peripheral IV Precepted Practice https://www.dynahealth.com/nursing-skills/inserting-an-ultrasound-guided- peripheral-iv#REFERENCES