Thanks to Lakshman Swamy for the tip for this one! US guided peripheral IV placement is a game changer. If you’re not doing this, you should. In fact, a lot of the RNs in our hospital are trained to do this now as well! It certainly saves time and pain (for us and our patients) when it comes to placing PIVs. In many cases, this can seriously reduce the need for central access and/or PICC/midline catheters.
A lot of patients can get by with PIVs, but are “hard sticks,” keep blowing IVs, or need more reliable catheters for blood draws. Using US to place these allows for selection of better, deeper veins that aren’t readily visible to the eye or amenable to palpation. And, this is 100% within the scope of practice for RNs, so train the RNs in your ICU to do this as well (note, you may have to address some hospital policies first). I’ve found when I train new ICU NPs, those with experience placing PIVs with US often pick up arterial line, PICC/midline, and central line placement much faster.
Brown EM Blog has a great post offering tips for success in US PIV placement. Additionally, 5 Minute Sono has some great videos. And finally, a nice CME article on the process is available here.
critical care notes 