CM: February 2014

Vascular Access Ultrasound

The Case

Ms. Timony is a 22 year old MVC patient on your surgery service. She has developed a perihepatic abscess following surgery. Interventional radiology is draining her abscess today and needs venous access to administer contrast. However Ms. Timony’s nurse has just informed you that the nursing staff has made 8 failed attempts at a peripheral IV. The surgery team discusses putting in an IJ central line, when you offer your services to put in an ultrasound guided peripheral IV (because you’re awesome and know you can use ultrasound to get peripheral IVs). You gather your IV supplies and your trusty ultrasound and head to Ms. Timony’s room. You scan her arm, find a vein, and establish a peripheral IV in less than 5 minutes. Ms. Timony thanks you for getting the IV, so she doesn’t have to get another “central line in her neck”. You leave the room happy that prevented Ms. Timony from experiencing the morbidity and mortality risks associated with central lines.

Suggested Resources

Introduction to Bedside Ultrasound: Vol. 2 Ch. 8

Ultrasound Podcast: Ultrasound-Guided Peripheral IV

ACEP Clinical Practice and Management: Dynamic Ultrasound-Guided Peripheral Intravenous Line Placement

The Quiz

Longitudinal Views

1. If you acquired the above image while placing an IV in Ms. Timony’s upper extremity, which technique did you use?

A)   Oblique       B)    Longitudinal        C)    Free Hand         D)   Transverse

Transverse View

2. If you acquired the above image while placing an IV in Ms. Timony’s upper extremity, which technique did you use?

A)   Oblique       B)    Longitudinal        C)    Free Hand        D)   Transverse

 3. In ultrasound imaging a normal vein appears?

A) Hyperechoic and compressible
B) Hyperechoic and non-compressible
C) Hypoechoic and compressible
D) Hypoechoic and non-compressible

4. Which of the following is true about the longitudinal approach?

A) It is the best approach to avoid neighboring structures.
B) Visualizes the entire length of the needle.
C) The vein appears as in short-axis, so it is round.
D) It is the preferred method for ultrasound-guided IV novices.

5. Which of the following is true about ultrasound-guided peripheral IV placement?

A) Use a 2.5 inch IV catheter for deep vein access.
B) You can improve needle visibility by bouncing it slightly.
C) There are no contraindications for ultrasound-guided peripheral IVs.
D) The needle will appear as a small bright dot with a dark shadow or bright repeating artifact.
E) All of the following are true.

 

(Answers: 1. b, 2. d, 3. c, 4. b, 5. e )

The Winner

Congratulations to Joe Chiles our winner of the Case of the Month! Enjoy your Starbucks winnings!!

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