I did not attend this presentation but I did hear lots of discussion
about it. There were several different interpretations of what he
said - 1) that all PIVs should be started with US and 2) that he used
US for all PIVs he started which were the difficult sticks he was
called to do. So it sounds to me like he left different impressions
with everyone. Lynn
At 5:30 AM -0700 5/19/06, Sally Walker wrote:
I did not get the impression that he was necessarily advocating that
all PIV's be placed with US, rather that he was demonstrating the
practice in his institution. As a relatively new IV Team member (and
a longtime nurse), and working nights alone, I recall a few
instances where US might have been of use--patients with very poor
peripheral potential (yes, candidates for PICC's and in our
institution, the PICC program and everything associated with it are
separate and under lock and key!), needing access...you know the
rest of the story. I could envision using the US to make the case
for central access, being able to show conclusively the absence of
peripheral possibilities. In the middle of the night, that is often
a difficult case to make.
What is imperative in any clinical situation is that the nurse use
her/his critical thinking skills, technical abilities, combined with
the tools at hand to ensure that the patient receives the best
possible care/treatment.
Sally
On May 18, 2006, at 3:08 PM, Katie Howard wrote:
My understanding is he was advocating that PIV's should be placed under
Ultrasound. Did you understand something different?
-----Original Message-----
From: Tim Talbert [mailto:[EMAIL PROTECTED]
Sent: Thursday, May 18, 2006 4:04 PM
To: Katie Howard; [EMAIL PROTECTED]; Sally Walker
Cc: [EMAIL PROTECTED]
Subject: RE: Ultrasound for periphs
What blanket statement did he make?
As an aside, I would place "evidence based-practice" far ahead of
policy or "standard" as a criterion.
Tim
"Katie Howard" <[EMAIL PROTECTED]> 5/18/06 >>>
We had an interesting conversation after his presentation. I have
never
seen so many hostile nurses in my life. He said many controversial
things that were not supported by policy, standard or even
evidence-based practice. The INS standard for PIV dwell time is 72
hours
unless there is a compelling reason to leave the line in longer. I
think
longevity of the PIV is more dependant upon location and infusate than
US use. Also, an important thing to consider is, how are you able to
hold traction on that vein during cannulation? The literature shows
the
importance of vein traction during insertion on phlebitis and thrombus
formation. Did anyone hear Lynn Hadaway's presentation on causes of
catheter complications? She had some very good points. I agree that
ultrasound can be a viable option for IV placement but to make a
blanket
statement concerning the use of ultrasound such as he did is not
supported in the literature nor does it make sense.
Katie Howard RN CRNI
Intermountain Infusion Pharmacy
IV Therapy Education
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Sally Walker
Sent: Thursday, May 18, 2006 9:12 AM
To: [EMAIL PROTECTED]
Cc: [EMAIL PROTECTED]
Subject: re: Ultrasound for periphs
Maureen Lawler (and others) have inquired and/or commented about
using ultrasound for peripheral vascular access. At the recent INS
conference, Richard Wade did quite an impressive presentation titled,
"Technologic Advances for Vascular Access Device Placement". Richard
is the PICC Clinician/Educator at PICC Advantage, LLC, in Queen
Creek, Arizona (I have no email contact information for him). He
focused his presentation on the use of ultrasound for peripheral
lines (of course they use US/MST for PICC's, as well), including
placement of lines in children. One of the notable outcomes they have
seen is the increased longevity of peripheral lines using US--most of
their lines last for 96 hours. Richard included a number of videos of
the actual ultrasound placement, so was able to demonstrate the
vessel assessment, catheter placement, etc.
If anyone is interested in pursuing this practice, Richard certainly
has the experience and seems willing to share what they have learned.
Sally Walker
Notice from St.Joseph Health System:
Please note that the information contained in this message may be
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--
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
