Placing PIV's in the lower arm with ultrasound will not increase the size of the vessel. Infiltration's and phlebitis are directly proportional to the hemodilution of the pH, osmolarity of a drug and patient vein condition. Size of vein does matter as the flow of blood to hemodilute drugs is limited. This leads to the same rate of complications as Maki proposed in his 1989 paper. Expected dwell time of a peripheral IV in the lower arm is at 48 hours for 50% of the PIV's placed. Take that into consideration when using US to place a PIV. How long is the expected therapy and what drug is given. Is this therapy going to last longer than 48 hours? Is this infusate a vesicant? US can be used for PIV's with good clinical judgement and patient assessment. Do I believe that this is happening. No! Responsible practice is a must. The average 18 gauge peripheral IV takes up 25% of the diameter of a hand vein whereas the average 5 French PICC line takes up 5% of the SVC. D! o the math. I did. Kathy
________________________________ From: [EMAIL PROTECTED] on behalf of [EMAIL PROTECTED] Sent: Tue 11/1/2005 10:29 AM To: [EMAIL PROTECTED] Subject: RE: Ultrasound for difficult PIV placement We are in the process (4 months) in collecting data on this. Unfortunately it does not cover all the PIV placed with ultrasound. Even with pretty talented staff, Lynn and others are absolutely right. Initial analysis of this data shows that many PIVs placed with ultrasound do not last 72 hours. Biggest complication - infiltration. If we are dealing with vesicants this can be disastrous. Everybody needs to remember that CT Contrast is a vesicant. Now with the extrasavation up high in the arm or at the antecub and deep - a lot worse trouble. Timothy Royer, BSN, CRNI > I am so glad to hear someone else with this same concern! US requires > that you dramatically alter venipuncture technique to insert a PIV. > There is no way that one person can hold the probe, hold the catheter > and hold traction on the skin during puncture and cannulation. This > last step is critical to reduce the trauma to the tunica intima - > trauma which leads to phlebitis, thrombosis, and infiltration. I > would encourage someone to collect outcome data on this to let us > know if our concerns are valid or if we are worrying for nothing! Lynn > > At 8:13 AM -0500 11/1/05, Cindy Schrum CRNI wrote: >>I have a study (the only one I could find on PIV with U/S) which was >>done in an ER. They can get the IV's in, but my concern has been >>who's taking data after they leave the ER? I've been tracking our >>IV's with U/S for the past 6 weeks. I'm not certain it's the best >>practice to be used routinely. We've had 2 thrombus out of probably >>(don't have it with me) IV starts. A longer, larger angiocath is >>used to access a vein deeper than you can see or feel. I'm still >>not convinced this is a good method. >>Cindy Schrum RN CRNI >>IVTeam Coordinator >>Gaston Memorial Hospital >>Gastonia, North Carolina >>(704) 834-2707 >>>>> "Andrea B. Cree" <[EMAIL PROTECTED]> 11/01/05 7:36 AM >>> >>Check out the article in October AJN >>Addresses PIV in ER. >> >>Andrea Cree, RN, OCN, CRNI >>Shore Health System >> >>-----Original Message----- >>From: Lori Kelly [mailto:[EMAIL PROTECTED] >>Sent: Monday, October 31, 2005 9:01 PM >>To: [EMAIL PROTECTED] >>Subject: Ultrasound for difficult PIV placement >> >>Group question: >>Do you have a policy in your facility for ultrasound for PIV placement? >>Do nurses other than PICC team use ultrasound for difficult PIV's? >> >> thanks in advance, >>Lori Kelly, RN >> >> >> >> >> >> >> >> >>----------------------------------------- >>This message and any included attachments are from CaroMont Health Inc. >>and are intended only for the addressee(s).The information contained >>herein may include trade secrets or privileged or otherwise >>confidential information. Unauthorized review, forwarding, printing, >>copying, distributing, or using such information is strictly prohibited >>and may be unlawful. If you received this message in error, or have >>reason to believe you are not authorized to receive it, please promptly >>delete this message and notify the sender by e-mail with a copy to >>[EMAIL PROTECTED] > > > -- > Lynn Hadaway, M.Ed., RNC, CRNI > Lynn Hadaway Associates, Inc. > 126 Main Street, PO Box 10 > Milner, GA 30257 > http://www.hadawayassociates.com > office 770-358-7861 > >
