Published data in a well designed, preferably randomized
controlled trial, is quite necessary. I am definitely interested in
the outcomes of the catheter, not your success rate with getting it
in. This would include specific vein used and location (not simply
right arm, left hand), catheter gauge, rates of phlebitis and
infiltration preferably expressed as the episodes per 1000 catheter
days.
Your personal experience is wonderful but it does not quite
measure up to the demands of evidence-based practice today. I would
strongly encourage you to do such a study and get it published in a
peer-reviewed journal. This would be adding to our knowledge base in a
truly meaningful way.
You make a good point about the difference between superficial
veins and deep veins and their tendency to roll around, but I still do
not understand how one person can accomplish holding the probe, the
catheter and skin traction all at the same time. Are you saying that
because you are using deep veins you do not need to hold traction? I
am wondering if you are truly using what the textbooks classify as
deep veins, which are located underneath muscle and contained in a
protective sheath with an artery and nerve. Or are you using
superficial veins that are deeper in connective tissue? Lynn
At 9:04 AM -0500 11/2/05, Brian Gackenbach wrote:
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Sorry...gotta reply:
quote: US requires that you dramatically alter venipuncture technique to insert a PIV.
Reply: Ok...so you have to learn a new technique...
quote: There is no way that one person can hold the probe, hold the catheter
and hold traction on the skin during puncture and cannulation.
Reply: Not true...and I'm not saying this as a matter of opinion...I'm saying it as a matter of fact. I do this on a daily basis and have done so for 5 years and have THOUSANDS of PIV insertions under my belt using U/S. I rarely stick w/o it.
Quote: This last step is critical to reduce the trauma to the tunica intima - trauma which leads to phlebitis, thrombosis, and infiltration.
Reply: Certainly...with shallow PIVs, just mm's under the skin...easily visible, easily palpable...yes...without anchoring (requiring your other hand) yes these viens do have a tendancy to roll around and make cannulation extremely challanging and as such leads to traumatic insertions and the complications you mention. I dont use U/S on visible veins...nearly all I cannulate are .5 - 1.0 cm deep and I do not have any trouble with veins of that depth rolling...as I am observing the ENTIRE process on U/S...I can assure you and anyone watching this...that there is potentially VERY little epithelial injury when done properly. I mean...I watch the TIP of the needle enter the vien...and KNOW I am in the vein and then cannulate. Gone are the days of inadvertently going through the vein or spending more than 5 sec's with a needle in my patient arm. Most often...I'm done in just a sec or two. My patients say, "Oh wow...you're done...really...that quick...and you got it...<insert big smile>...I love you Mr. IV man!". Blind sticks (palpating only) are a thing of the past for me and my patients. Our outcomes are such that we routinely have patients who ONLY allow us to come place their IV's. Phlebitis is not a problem here for us.
If it takes an actual study done, where I have to track the PIV's I do and show you guys raw #'s rather than recant personal experience from many years and thousands of sticks, then I may be persuaded to conduct this little study. All of our staff here routinely us U/S for PIV's....if there was an increase in complications from this practice...given the large # of time we do this...we'd have observed it w/o any need for an official study determine it existed. Alas...if need be...I'll <gulp> volunteer to investigate this. Email me with data you'd like to see (Ie: # of attemps, cath size/length...vein used..etc.) I'll whip up a Palm data collection tool and see if I can get my dept. to cooperate and we'll monitor and report on this data for you...possibly seek publishing it if you guys think it warrants it.
Brian
Brian Gackenbach RN, CRNI
IV Nurse Specialist
U of L Hospital
Louisville, KY 40202
(502) 562-3530 off.
(502) 562-3836 fax.
(502) 336-8816 pgr.
[EMAIL PROTECTED]
>>> "Lynn Hadaway" <[EMAIL PROTECTED]> 11/01/05 8:21 AM >>>
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
>
>
>
>
>
>
>
>
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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
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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
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
