I also use the sterile gel for the actual stick. I have found that using a longer catheter (20g, 1.75 inch) and backing down away from the probe, so that I can insert at about a 45 degree angle (instead of against the probe at a 75 degree angle) increases the success of maintaining the site. I have not noticed an increase in phlebitis.
As regards the discussion about "what about the next required site," presumably one is not inserting a PIV for this patient without assessing for the patient's need. If therapy is to continue, we discuss options with the physician. If it isn't appropriate to continue to use PIVs, our team can decline the referral to insert one.
Leigh Ann
-----Original Message-----
From: Tami Spaeder <[EMAIL PROTECTED]>
To: Laura Cook RN <[EMAIL PROTECTED]>; [EMAIL PROTECTED]
Sent: Thu, 18 May 2006 17:01:01 -0700
Subject: RE: ultrasound for peripherals
In Our facility, when starting a PIV using U/S, we set up a sterile field (yes, more time consuming!) and use the sterile U/S gel packs--can open them up on your sterile field. Then proceed using a vein below the AC, wearing sterile gloves, etc. Tami Spaeder, RN, BSN Olympic Medical Center, Port Angeles -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] On Behalf Of Laura Cook RN Sent: Wednesday, May 17, 2006 7:39 AM To: [EMAIL PROTECTED] Subject: RE: ultrasound for peripherals I discourage the practice of starting peripheral IV's using the u/s at our hospital...unless it is in an emergent situation. If the patient requires an IV using the u/s, how will the their next IV need to be obtained? Would they be better off by placing a PICC or midline? We noticed an increased rate of phlebitis when we started using the u/s to start peripheral IV sites. Could it be in relation to using the non sterile u/s gel...or the inability to apply tension on the vein while holding the u/s ...or using veins that are too deep to be accessed using a peripheral IV catheter. I also ask my nurses to follow up with in 24 hours of insertion to assess if the patient needs some other form of access....and do a site check on theIV. Lynn, am I wrong for being so hesitant with this practice? What does research say? Your feed back would be much appreciated. Thanks, Laura ----------------------------------------- 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]
