This lecture was presented at the 2021 Maine Medical Center Winter Symposium. For more information on the symposium click here.

Key concepts for Ultrasound Guided IV placement

LENGTH
- Always use long IV (1.88 inches) catheters or it will pull out of the vessel.
FLASH
- Do NOT look for flash, you should watch the needle all the way into the vessel to ensure your location.
- Threading the catheter when you see flash has a high likelihood of having the catheter go through the back wall of vessel and into the subcutaneous tissue or on top of the vessel (because the needle backed out before threading it).
TIP
- There are two good ways to ensure you are seeing the tip of your needle and not some other part of it:
  - Longitudinal approach - this works great but is difficult if you don’t have experience with it
  - “Catch and release” - constantly lose the white dot and then have it reappear as you advance the needle, ensuring that the dot on the screen represents the tip
    - Move only one hand at a time-- either the probe (while the needle stays still) or the needle (while the probe stays still)

Additional Tips

Set yourself up for success!
- Have a straight line from your body, to the patient’s arm, to the screen so you only have to move your eyes up and down.
Use a tourniquet when you LOOK for the vein as well as when you place the IV otherwise the pressure from the probe will compress the veins and you won’t find anything.
Consider the use of lidocaine if a patient has has repeated attempts at IV placement.
If you have trouble seeing the needle echo, hold the needle still and fan the probe to be more perpendicular with the needle.
Use distal and superficial veins whenever possible (preferrably forearm and < 1 cm deep).
- Veins 1cm deep have a high percentage of blowing. [1]

References

Fields JM et al. The effect of vessel depth, diameter and location on ultrasound-guided peripheral catheter longevity. Am J Emerg Med. 2012 Sep;30(7):1134-40. [Pubmed]