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Nadine:
Nerves do have a very distinctive appearance on ultrasound, but cannot be seen with the older mechanical ultrasounds. I have no trouble with the I-Look, which is the only digital ultrasound I currently have.
In response to Lynn's point about manufacturers not making statements about whether you can use their ultrasound to locate nerves, I must disagree. While it may not be noted in the manual, when a company representative is sent to teach use of the ultrasound for nerve identification, this counts as labeling also. I have been in a class taught by a sonographer, who was working for an ultrasound manufacturer. He had been sent to teach a group of anesthesiologists the use of their ultrasound specifically for nerve identification and nerve blocks.
Perhaps the skill of nerve identification would be a good roundtable presentation at the next AVA conference.
Leigh Ann
Leigh Ann Bowe-Geddes, RN, CRNI
IV Therapy Specialist
Infusion Services Department
University of Louisville Hospital
Louisville, KY
502-562-3530
>>> "Nadine Nakazawa" <[EMAIL PROTECTED]> 9/15/2006 8:19 PM >>>
Sometimes the median nerve is easy to see with US, but sometimes it isn't. Depends on the US machine too. The real key for me is if the patient's arm "jumps" when I insert or advance the needle. It's pretty distinctive, even in a comatose patient. Of course, if the patient is awake they let you know that it hurts and feel's "like an electric shock down my arm". If you leave the needle there , they will tell you they still feel that pain and/or their fingers tingle uncomfortably.
Must pull out the needle.
Nadine Nakazawa, RN, BS, OCN PICC Program Coordinator
Stanford University Hospital and Clinics
Stanford University Medical Center
From: "Ward Gina" <[EMAIL PROTECTED]>
To: "Lynn Hadaway" <[EMAIL PROTECTED]>, "Bev and Tim Royer" <[EMAIL PROTECTED]>, [EMAIL PROTECTED]
Subject: RE: RT's using US for ABG's
Date: Fri, 15 Sep 2006 17:18:58 -0400
Could anyone share any info , or point me in the direction of using the ultrasound and assessing avoiding nerves during picc insertion.
Are we just talking a knowledge of anatomy and where the nerves are located and accessing the vein properly to avoid the nerve where we would expect it to be located. OR is there a way toidentify these nerves on the ultrasound.
thanks, gina
From: [EMAIL PROTECTED] on behalf of Lynn Hadaway
Sent: Fri 9/15/2006 1:04 PM
To: Bev and Tim Royer; [EMAIL PROTECTED]
Subject: RE: RT's using US for ABG's
And I would agree with Tim and the others that have serious
reservations about this practice. Lynn
At 7:02 AM -0700 9/15/06, Bev and Tim Royer wrote:
>Another thing we need to think about is nerve damage. My veins even on a
>good day at the antecub are not easy to find and I have had some probe and
>some extreme pain when they go deep. I truly believe that ultrasound needs
>to be left those who use it all the time and have a deep knowledge of
>anatomy and physiology and aseptic technique. This could end up with more
>facilities going to court over nerve damage and/or infection. If a
>phlebotomist or RT has the same education as a RN with critical thinking
>skills in this area, I might think differently.
>
>Using ultrasound is not just a skill.
>
>Timothy Royer, BSN, CRNI
>Nurse Manager / Vascular Access / Diagnostic Service
>VA Puget Sound Heal
th Care System
>Seattle, WA
>
>PS - AVA Conference in Indy was a great time and informative! It has taken
>me a few days to rest up.
>
>-----Original Message-----
>From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]]
>On Behalf Of Erickson, Wendy
>Sent: Friday, September 15, 2006 4:38 AM
>To: DAVID LONGSETH; [EMAIL PROTECTED]
>Subject: RE: RT's using US for ABG's
>
>Use caution! We had an outbreak of infections related to contaminated
>ultrasound gel several years ago. The bottles were being refilled from a
>large supply, rather than using a new bottle when empty. I would be very
>concerned about using non-sterile gel anywhere near a venipuncture site.
>
>Wendy Erickson RN
>
>-----Original Message-----
>From: [EMAIL PROTECTED]
>[mailto:[EMAIL PROTECTED]] On Behalf Of DAVID LONGSETH
>Sent: Thursday, September 14, 2006 8:52 PM
>To: [EMAIL PROTECTED]
>Subject: RT's using US for ABG's
>
>Similar to the 'phlebotomists using US' but different enough for another
>thread.
>A couple of our RT's are interested in using US for ABG's. The training and
>competencies shouldn't be too hard to do,and they have access to a Site-Rite
>2. What I'd like to do is a pre-audit of palpation ABG's in terms of time to
>get the sample and # of sticks,then train a few in US guidance and then see
>how the times,sticks to pt. and materials used compare.
>Now,the one thing that I still can't decide is whether to have them use a
>sterile sleeve over the probe or not. Drawing ABG's is not a sterile
>procedure per se,so my instinct is to have them disinfect the probe before
>and afte
r the stick but maybe someone out there has other views.
>Thaks for any input,
>David
>
>
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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
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