Bret P. Nelson, MD, RDMS, FACEP
Bret Nelson is a Professor of Emergency Medicine, Chief of the Emergency Medicine Ultrasound Division at the Icahn School of Medicine at Mount Sinai, Chief Editor of the ultrasound education website, www.SinaiEM.us. He is on the board of directors of the Society for Clinical Ultrasound Fellowships and active in the American College of Emergency Physicians (ACEP)’s Ultrasound Section and is among the authors of ACEP’s Emergency Ultrasound Guidelines. Served on the Board of Directors of the World Interactive Network Focused on Critical Ultrasound (WINFOCUS) and was Chair of the American Institute of Ultrasound in Medicine’s Point of Care Community of Practice.
Authored several books, Manual of Emergency and Critical Care Ultrasound, Emergency Medicine Oral Board Review Illustrated, Atlas of Handheld Ultrasound, and Acute Care Casebook.
Dr Nelson has lectured throughout the world on the use of point-of-care ultrasound to aid medical decision-making and improve patient safety. His research interests include ultrasound and medical education.
“10 years ago a patient will say, ‘Only Mary on the 9th floor is going to get near my vessels’….now the patients say, ‘I’m a tough stick, so use ultrasound.’
It’s almost like anyone can get a pass from the patient’s perspective…ultrasound is the great equalizer.” ~Bret Nelson
Can RNs perform USG PIV safely? Yes!
Within Nursing Scope of Care!! Yes!!
American Institute of Ultrasound in Medicine (AIUM) White Paper in conjunction with:
American Academy of Physician Assistants (AAPA)
American Association of Critical Care Nurses (AACN)
American Association of Nurse Anesthetists (AANA)
American Society of Diagnostic and Interventional Nephrology (ASDN)
American College of Emergency Physicians (ACEP)
American Society of Echocardiography (ASE)
Association of Physician Assistants in Cardiovascular Surgery (APACS)
Association for Vascular Access (AVA)
Infusion Nurses Society (INS)
Renal Physicians Association (RPA)
Society of Diagnostic Medical Sonography (SDMS)
Society for Vascular Ultrasound (SVU)
Nurses are masters at IV insertions
- Ultrasound is another tool in the tool belt for difficult IV access.
- Ultrasound is a natural progression for nurses who are experienced in obtaining IV access
- Nurses have the best tricks to get those tough IV lines like applying heat.
- Nurses already use other technology including infrared light, LED, and head lamps
Journal articles show high success rate!
- ~85 after approximately 10-15 attempts
- ~95% after approximately 20-25 attempts
- Too many articles – click here for dropbox link and easy download.
Empowering nurses with an advanced skill
- Nurses are able to identify a patient as a hard stick and obtain IV access with ultrasound without waiting for a physician to place the IV.
- Nurses who need to develop their IV skills have a skill to strive for.
Nurses are able to identify patients who are a hard stick. Patients have reduced failed attempts prior to an ultrasound guided placed IV access.
Essentially, patients get stuck less but get good results. Patients know they are a hard stick – they are happy.
Who Should be getting USG PIV?
Patients who have difficult intravenous access.
*If you can place an IV in a conventional or traditional method, do it. ~Yun Cee
Identified difficult IV access populations:
- Sickle Cell
- Repeat Hospital Admissions
- IV Drug Abuse
Reduces CLABSI by NOT placing central venous lines because you have peripheral IV access.
- AIUM Practice Parameter for the Use of Ultrasound to Guide Vascular Access Procedures. (2012). American Institute of Ultrasound in Medicine. https://www.aium.org/resources/guidelines/usGuidedProcedures.pdf
- Au, A. K., Rotte, M. J., Grzybowski, R. J., Ku, B. S., & Fields, J. M. (2012). Decrease in central venous catheter placement due to use of ultrasound guidance for peripheral intravenous catheters. The American Journal of Emergency Medicine,30(9), 1950-1954. http://dx.doi.org/10.1016/j.ajem.2012.04.016
- Brannam, L. (2004). Emergency Nurses Utilization of Ultrasound Guidance for Placement of Peripheral Intravenous Lines in Difficult-access Patients. Academic Emergency Medicine,11(12), 1361-1363. doi:https://doi.org/10.1197/j.aem.2004.08.027
- Costantino, T. G., Parikh, A. K., Satz, W. A., & Fojtik, J. P. (2005). Ultrasonography-Guided Peripheral Intravenous Access Versus Traditional Approaches in Patients With Difficult Intravenous Access. Annals of Emergency Medicine,46(5), 456-461. doi:https://doi.org/10.1016/j.annemergmed.2004.12.026
- Duran-Gehring, P., Bryant, L., Reynolds, J. A., Aldridge, P., Kalynych, C. J., & Guirgis, F. W. (2016). Ultrasound-Guided Peripheral Intravenous Catheter Training Results in Physician-Level Success for Emergency Department Technicians. Journal of Ultrasound in Medicine,35(11), 2343-2352. doi:https://doi.org/10.7863/ultra.15.11059
- Emergency Nurses Association. (2015). Clinical Practice Guideline: Difficult Intravenous Access. https://www.ena.org/docs/default-source/resource-library/practice-resources/cpg/difficultivaccesscpg.pdf?sfvrsn=9944da58_12
- Feinsmith, S., Huebinger, R., Pitts, M., Baran, E., & Haas, S. (2017). Outcomes of a Simplified Ultrasound-Guided Intravenous Training Course for Emergency Nurses. Journal of Emergency Nursing. doi:https://doi.org/10.1016/j.jen.2017.10.001
- Fields, J. M., Dean, A. J., Todman, R. W., Au, A. K., Anderson, K. L., Ku, B. S., . . . Panebianco, N. L. (2012). The effect of vessel depth, diameter, and location on ultrasound-guided peripheral intravenous catheter longevity. The American Journal of Emergency Medicine,30(7), 1134-1140. doi:https://doi.org/10.1016/j.ajem.2011.07.027
- Moore, C. (2013). An Emergency Department Nurse-Driven Ultrasound-Guided Peripheral Intravenous Line Program. Journal of the Association for Vascular Access,18(1), 45-51. http://dx.doi.org/10.1016/j.java.2012.12.001
- Oliveira, L., & Lawrence, M. (2016). Ultrasound-Guided Peripheral Intravenous Access Program for Emergency Physicians, Nurses, and Corpsmen (Technicians) at a Military Hospital. Military Medicine,181(3), 272-276. doi:https://doi.org/10.7205/MILMED-D-15-00056
- Schoenfeld, E., Boniface, K., & Shokoohi, H. (2011). ED technicians can successfully place ultrasound-guided intravenous catheters in patients with poor vascular access. The American Journal of Emergency Medicine,29(5), 496-501. doi:https://doi.org/10.1016/j.ajem.2009.11.021
- Shokoohi, H., Boniface, K., Mccarthy, M., Al-Tiae, T. K., Sattarian, M., Ding, R., . . . Yadav, K. (2013). Ultrasound-Guided Peripheral Intravenous Access Program Is Associated With a Marked Reduction in Central Venous Catheter Use in Noncritically Ill Emergency Department Patients. Annals of Emergency Medicine,61(2), 198-203. http://dx.doi.org/10.1016/j.annemergmed.2012.09.016
Cite this post as:
Dirsa, Y. (Host). September 12, 2018. 021 Nurses Placing Ultrasound Guided IV Access w/Bret Nelson, MD. [Audio podcast episode]. In Resus Nurse Podcast and Blog. https://resusnurse.com/2018/09/12/021-nurses-placing-ultrasound-guided-iv-access-w-bret-nelson-md/.
Now Listen to the Episode…