Ultrasound Guided IVs

Ultrasound Guided IVs

Advancing patient care in the emergency department.

Historically, placing a peripheral IV involved using a tourniquet, identifying veins by touch and doing a blind stick. While many of our emergency department nurses are highly skilled at this, certain patient populations present significant challenges.

In cases where patients have been sick for extended periods of time, are on steroids, have low blood pressure, are obese, have been treated with dialysis or chemotherapy, or were recently transferred to Boone Hospital, additional needles can create significant discomfort, leading to delays in treatment.

To address this issue, the Emergency Department implemented a program to train nurses in ultrasound guided IV placement. Using the SonoSite X-Porte portable ultrasound machine, nurses are trained before using the machine to place IVs.

This program was implemented 7 years ago and benefits the patient with fewer needle sticks, better patient comfort and getting medications delivered earlier. In many cases, a patient who must stay in the hospital is able to use the ultrasound guided IV for their entire stay.

If you’re a patient needing an ultrasound guided IV, you will first be placed lying down or in a reclined seat for comfort and access to your arm. A tourniquet will be applied and then your arm will be cleaned thoroughly. A sterile ultrasound gel will be applied, and the nurse will start using the ultrasound to evaluate the different vessels. While the nurse is looking, they will be pressing around on the arm and sliding the gel around as they look for the right place to stick the needle. If numbing medication is used, that allows the nurse more time to manipulate the needle without causing a lot of pain.

If numbing medicine is not used, after a vessel has been selected, a longer needle will be used. Although the needle itself may look scary, it’s not a bigger needle, it’s just longer. After the skin has been punctured, they’ll guide the needle, watching it on the ultrasound machine the entire way, until it’s in the vessel. Then they’ll slide the catheter in, clean up the arm, connect it to the IV, and do whatever else they need to, like draw blood or administer medicine.

The biggest difference between a regular IV and an ultrasound guided IV is pressing around with the probe and the gel on the arm. But those things have to be cleaned up before they can put tape or stickers on to hold it in place.

For most patients, this process can take 10 minutes, compared to 1-2 minutes with a traditional IV. For patients who are on dialysis, receiving cancer therapies or on long term steroids, they become more challenging, and in some cases, it can take closer to 15 minutes.

Under ultrasound guidance, nurses can tell the difference between veins and arteries. If they’re sticking in a sensitive area, they know exactly where they’re at, which makes it very easy.

Nurses report that they can see exactly where the needle is going. It’s kind of like x-ray vision, without the x-ray.

Ultrasound is a safe and effective way to see what’s going on under the skin. Ultrasound doesn’t use any radiation, it uses sound waves, so it’s completely safe.

This is a huge benefit to patients who are very nervous about needles and those patients who have a long history of medical complications. When they come to the hospital, they may get stuck repeatedly, and no one wants that. Using the machine, nurses can have medicine into patients quicker and more efficiently without having to stick them multiple times.

Having enough staff to do this means patients don’t have to worry. It’s less painful and their treatment happens quicker versus having to wait for a specialist to come in and do it.

The machine in the emergency department is a multifaceted machine. It can look at abdominal organs like gallbladders, and kidneys, perform basic cardiac evaluations and assess heart function, and see and hear fetal imaging and precise heart tones for babies. The funding for this machine was provided by the Boone Health Foundation.

It's mobile, on wheels, so it's able to move around. With the number of people increasing who are needing ultrasound guided IVs, it's in use a lot. Our ICU and Infusion and Treatment Center also have these ultrasound machines.

As a staff educator, whenever high school students come through here for a tour, I tell them, this is the future. As you go to nursing school, this is what you need to learn, because it gives us more information quicker than sending someone over to CT or X-ray. Sometimes, those are appropriate, but this gives us instant information at the bedside.

By Jesse Godec, Staff Educator, Emergency Department