Peripheral Intravenous Line Access

2021 ◽  
pp. 113-120
Author(s):  
Tristan Levey ◽  
Andrew Wuenstel ◽  
Amanda Foley
Keyword(s):  
Significant Variation ◽  
Cephalic Vein ◽  
Medial Malleolus ◽  
Basilic Vein ◽  
Intravenous Access ◽  
Intravenous Line ◽  
Dorsal Vein ◽  
Radial Side ◽  
Peripheral Intravenous Catheter ◽  
Median Cubital Vein

A peripheral intravenous catheter is used to access a peripheral vein. To start a peripheral intravenous line, identify the site, place a tourniquet, clean the skin, stabilize the vein, and insert the catheter. When a “flash” is obtained, thread off the catheter, connect it to the tubing, and secure. This chapter describes tips for finding common intravenous access sites in children, which are the metacarpal, saphenous, cephalic, median, and scalp veins. These veins vary in size, depth, and difficulty. Metacarpal/dorsal hand veins are on the dorsal aspect of the hand and typically arise from adjacent digital veins and form a network that usually provides several targets for access, although there is significant variation. These veins form the cephalic vein (radial side) and basilic vein (ulnar side) as they converge. The cephalic vein arises from the lateral (radial) side of the dorsal venous network before curving around the wrist to run along the anterolateral forearm, where it is frequently easily accessed. It continues on this course up the arm, but more proximally it is less superficial. The median cubital vein runs from the cephalic vein medially toward the basilic vein diagonally across the antecubital fossa and is reliably present if not always visible. The greater saphenous vein is formed on the foot from the dorsal vein of the great toe and the dorsal venous arch of the foot. It ascends anteriorly to the medial malleolus and superiorly up the medial calf.

Cutdowns for Totally Implantable Access Ports to Central Veins

Vascular ◽  
2009 ◽  
Vol 17 (5) ◽  
pp. 273-276 ◽  
Author(s):  
Mahmoud Kulaylat ◽  
Constantine P. Karakousis
Keyword(s):  
Success Rate ◽  
Internal Jugular Vein ◽  
Superior Vena Cava ◽  
Jugular Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
External Jugular Vein ◽  
Cephalic Vein ◽  
Seldinger Technique ◽  
Basilic Vein

For insertion of totally implantable access ports, with the catheter end in the superior vena cava, the percutaneous (Seldinger) technique is commonly used. Of cutdowns, the cephalic vein cutdown is the most popular one (success rate about 80%), followed by the external jugular vein cutdown. Our preliminary experience suggests that internal jugular vein and basilic vein cutdowns have the anatomic features to prove both of them superior to the cephalic vein cutdown.

A Two-Staged Technique for Basilic Vein Transposition

2007 ◽  
Vol 8 (4) ◽  
pp. 225-227 ◽  
Author(s):  
A.R. Pasch
Keyword(s):  
Cephalic Vein ◽  
Single Stage ◽  
Basilic Vein

The dilemma of creating a fistula in patients without a useable cephalic vein can be addressed by basilic vein transposition, yet results of the classic single-stage procedure are inconsistent and surgeon utilization of this procedure is variable. This article describes a two-staged technique for basilic vein transposition. The two-staged technique is likely to facilitate higher fistula rates in patients unable to have a direct fistula, and warrants consideration by surgeons striving to achieve higher fistula rates

Guidelines for the Elective Use of Conscious Sedation, Deep Sedation, and General Anesthesia in Pediatric Patients

PEDIATRICS ◽  
1986 ◽  
Vol 77 (5) ◽  
pp. 754-754
Author(s):  
Keyword(s):  
General Anesthesia ◽  
Pediatric Patients ◽  
Conscious Sedation ◽  
Deep Sedation ◽  
Intravenous Access ◽  
Intravenous Line ◽  
Intravenous Infusions

Clarification The AAP Committee on Drugs and Section on Anesthesiology wish to clarify those portions of the Guidelines (Pediatrics 1985;76:317-321, August) that pertain to an intravenous line. Under some circumstances (eg, very short procedures, availability of persons skilled in establishing intravenous lines in children), it may not be necessary that an intravenous line be in place. Therefore, the Guidelines are modified as follows. In section II, "Deep Sedation," the recommendation should read: Patients receiving deep sedation should have an intravenous line in place or have immediately available a person skilled in establishing intravenous infusions in pediatric patients. In section III, "General Anesthesia: Intravenous Access," the recommendation should read: Patients receiving ambulatory general anesthesia shall have an intravenous line in place or have immediately available a person skilled in establishing intravenous infusions in pediatric patients.

Peripheral Intravenous Access: Applying Infusion Therapy Standards of Practice to Improve Patient Safety

2019 ◽  
Vol 39 (1) ◽  
pp. 61-71 ◽  
Author(s):  
Barb Nickel
Keyword(s):  
Early Recognition ◽  
Improve Patient Safety ◽  
Hospital Setting ◽  
Infusion Therapy ◽  
Intravenous Catheter ◽  
Intravenous Access ◽  
Standards Of Practice ◽  
Peripheral Intravenous Catheter ◽  
Therapy Standards ◽  
Peripheral Intravenous Access

The most common invasive procedure performed in the hospital setting worldwide is the insertion of a peripheral intravenous catheter. Although use of peripheral intravenous access is common, its presence is far from benign, with a reported 35% to 50% failure rate, even in facilities with a dedicated infusion team. Significant complications related to the presence of a peripheral intravenous site include localized infection, bacteremia, phlebitis, and infiltration or extravasation. Consistent application of evidence-based standards of practice in all aspects of peripheral intravenous catheter care is essential to provide infusion therapy that delivers safe and quality care. Management of peripheral intravenous access in the complex setting of critical care is examined in this article. A case study approach is used to illustrate application of infusion therapy standards of practice in peripheral intravenous catheter insertion, indications for catheter placement, and assessment parameters to enhance early recognition of peripheral intravenous access–related complications.

Defining difficult intravenous access (DIVA): A systematic review

2021 ◽  
pp. 112972982110596
Author(s):  
Amit Bahl ◽  
Steven Johnson ◽  
Kimberly Alsbrooks ◽  
Alicia Mares ◽  
Smeet Gala ◽  
...  
Keyword(s):  
Physical Examination ◽  
English Language ◽  
Traumatic Experience ◽  
Intravenous Access ◽  
Clinical Trial Registries ◽  
Language Studies ◽  
Prevalence Estimates ◽  
Peripheral Intravenous Catheter ◽  
History Of ◽  
Definition Of

Background: The term “difficult intravenous access” (DIVA) is commonly used but not clearly defined. Repeated attempts at peripheral intravenous catheter (PIVC) insertion can be a traumatic experience for patients, leading to sub-optimal clinical and economic outcomes. We conducted a systematic literature review (SLR) to collate literature definitions of DIVA, with the aim of arriving at an evidence-driven definition. Methods: The SLR was designed to identify clinical, cost, and quality of life publications in patients requiring the insertion of a PIVC in any setting, including studies on US-guidance and/or guidewire, and studies with no specific intervention. The search was restricted to English language studies published between 1st January 2010 and 30th July 2020, and the Ovid platform was used to search several electronic databases, in addition to hand searching of clinical trial registries. Results: About 121 studies were included in the SLR, of which 64 reported on the objectives relevant to this manuscript. Prevalence estimates varied widely from 6% to 87.7% across 19 publications, reflecting differences in definitions used. Of 43 publications which provided a definition of DIVA, six key themes emerged. Of these, themes 1–3 (failed attempts at PIV access using traditional technique; based on physical examination findings for example no visible or palpable veins; and personal history of DIVA) were covered by all but one publication. Following a failed insertion attempt, the most common number of subsequent attempts was 3, and it was frequently reported that a more experienced clinician would attempt to gain access after multiple failed attempts. Conclusions: Considering the themes identified, an evidence-driven definition of DIVA is proposed: “when a clinician has two or more failed attempts at PIV access using traditional techniques, physical examination findings are suggestive of DIVA (e.g. no visible or palpable veins) or the patient has a stated or documented history of DIVA.”

Evaluation of a Pilot Educational Program on Safe and Effective Insertion and Management of Peripheral Intravenous Catheters

2015 ◽  
Vol 20 (1) ◽  
pp. 37-42 ◽  
Author(s):  
Niall Higgins ◽  
Samantha Keogh ◽  
Claire Rickard
Keyword(s):  
Learning Styles ◽  
Registered Nurses ◽  
Vascular Access ◽  
Individual Student ◽  
Research Knowledge ◽  
Intravenous Access ◽  
Postgraduate Level ◽  
Peripheral Intravenous Catheter ◽  
Peripheral Intravenous Access ◽  
Intravascular Devices

Abstract Peripheral intravenous catheter (PIVC) insertion and subsequent care have been highlighted as areas for improvement in the management of intravascular devices; however, only the fundamentals of PIVC care are routinely taught to registered nurses in Australia. In 2013, a vascular access-focused elective postgraduate course, Peripheral Intravenous Access and Care (8035NRS) was commenced for students enrolled in any of the Griffith University master's degree programs. It was developed with the intent to translate research knowledge into practice by providing access to the latest research findings and current best practices in peripheral intravenous access. Topics covered preinsertion, insertion, and postinsertion care and were developed for the online environment, which is known to be conducive to individual student learning styles. Learning activities included viewing short videos delivered by local and international clinical researchers. This course is the first known university-provided, postgraduate academic course on this subject in Australia, and possibly 1 of the few available internationally. The course succeeded in its aim of increasing knowledge and skills about safe, evidence-based PIVC insertion and care to registered nurses. Its development and implementation at the postgraduate level may be regarded as a strategy to provide a greater understanding regarding scope and relevance for nursing practice and for informed decision making on optimum integration at the undergraduate level. This ultimately will increase positive patient outcomes and the patient experience of vascular access.

Vein Measurement by Peripherally Inserted Central Catheter Nurses Using Ultrasound: A Reliability Study

2013 ◽  
Vol 18 (4) ◽  
pp. 234-238 ◽  
Author(s):  
Rebecca Sharp ◽  
Andrea Gordon ◽  
Antonina Mikocka-Walus ◽  
Jessie Childs ◽  
Carol Grech ◽  
...  
Keyword(s):  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Cephalic Vein ◽  
Basilic Vein ◽  
Rater Reliability ◽  
Vein Thrombosis ◽  
Intraclass Correlation Coefficients ◽  
Measurement Protocol ◽  
Brachial Vein ◽  
Deep Vein

Abstract Background: Peripherally inserted central catheters (PICCs) are increasingly inserted by trained registered nurses, necessitating the development of specialized skills such as the use of ultrasound. The selection of an adequately sized vein is an important factor in reducing adverse events such as deep vein thrombosis. However, PICC nurses may receive minimal training in the use of ultrasound for vein measurement. Objective: We aimed to demonstrate the reliability of a vein measurement protocol using ultrasound by a PICC nurse trained in sonography. Methods: The diameter of the basilic, brachial, and cephalic veins in the left arms of healthy participants (n =12) were measured using ultrasound by a PICC nurse and a sonographer. A PICC nurse performed the measurement twice and the sonographer once; the PICC nurse's results were compared for intra-rater reliability and compared with the sonographer for inter-rater reliability. The results were analyzed using intraclass correlation coefficients (ICCs). Results: Inter-rater reliability between the PICC nurse and the sonographer was adequate, the ICC for the brachial vein was 0.60 (95% confidence interval [CI], 0.06–0.87), basilic vein ICC was 0.87 (95% CI, 0.58–0.96) and cephalic vein ICC was 0.77 (95% CI, 0.39–0.93). Intra-rater reliability of the PICC nurse was higher; the ICC for the brachial vein was 0.80 (95% CI, 0.44–0.94), basilic vein ICC was 0.92 (95% CI, 0.67–0.98), and cephalic vein ICC was 0.78 (95% CI, 0.40–0.93). Conclusions: Using a suitable protocol, a PICC nurse was able to measure vein diameter reliably when compared with a sonographer and consistently replicate these results.

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