1. Ultrasound-Guided PIV Access

2. Study Details… Prospective cohort study St Lukes & Roosevelt sites
MD’s: residents & attendings
Patients with “difficult access”
2+ unsuccessful PIV attempts
Exclusion
Unstable
Unable to obtain consent

3. Study Details… Primary Outcomes
Attempt
Skin puncture
Redirection
Partial withdrawal, needle advancement
to change catheter direction
Timing
Tourniquet placement to successful IV placement
Flash
Infuse 5mL saline
Failure >4 US-guided attempts

4. Enrollment Process Identify eligible patients
All ages
2+ failed PIV attempts
Contact AA’s (when available)
Consent, assent
Data Sheet
Demographic info
PIV placement: MD’s Thermal image
2nd 1/2 Data Sheet

5. Data
Sheet
(TOP)

6. Materials Consents Data Sheet Sonosite Titan Stop-watch Tourniquet
High frequency linear probe
Stop-watch
Tourniquet
Gel/sterile lube
Saline Flush
Gauze, tape

7. Peripheral IV Access Superficial & deep vessels Antecubital region
Saphenous

8. US-Guided PIV Technique
Linear, high frequency transducer
7.5 MHz
Short axis
Dynamic
Real-time guidance
Dual operator

9. Technique: Short Axis Transverse Needle is perpendicular to transducer
Cross section
Needle is perpendicular to transducer
OK to use long axis
for confirmation
Compression
Arteries vs. veins

10. Dual Operator “Probe person” “Needle person”
Orient probe, center vessel on screen
Tell needle person depth (distance from probe)
Guide redirections
“Needle person”
Focus on probe, center needle

11. Needle Placement a b c
Enter at 45 degree angle… a2+b2=c2

12. What You’re Looking For: Short Axis
Tenting
Ring-down artifact

13. Data
Sheet
(BOTTOM)
Timing
Stopwatch
(sec)

14. Helpful Hints…
Flash not always seen, even w/ US confirmation of intravascular placement
Catheter kinks are frequent
24-gauge needles
45 degree angle
Securing catheter flush against skin
Maintain angle of entry w/ folded gauze under IV catheter
Use long catheters when available

15. Questions? Stephanie Doniger, MD Will Bagley, MD US Division
Resa Lewiss, MD
Marina Del Rios, MD
Alexis Langsfeld, MD
Turandot Saul, MD