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On your rotation, you will be taught how to perform ultrasound-guided vascular access on a gel model.
Prior to this education, which will occur later in your rotation, do not respond to any nursing or treatment team requests to place an IV, despite whatever comfort level you may have with the procedure prior to the start of this rotation, unless you are able to do so with supervision by one of your ultrasound fellowship-trained attendings, or the resident / attending assigned to that patient.
While it may be "just an IV," in our department, it is still a procedure that requires sign-off to perform, or, requires supervision / permission from the treatment team.
You may, of course, observe and assist with any such procedures that are going on.
It is very important to check with the patient, nursing, & the treating team prior to placing any IV's to ensure which extremities are and are not safe for IV placement, as some patients have "limb alerts" that prevent a line being placed in certain body areas.
It is very important to check with the patient, nursing, & the treating team prior to placing any IV's to ensure which extremities are and are not safe for IV placement, as some patients have "limb alerts" that prevent a line being placed in certain body areas.
Training versus point-of-care
Training versus point-of-care
After receiving your vascular access education, you may find patients who need an IV placed with ultrasound-guidance, or who are willing to let you practice placing an IV on them.
If a patient is allowing you to place one on them, and it was not requested to be done with ultrasound guidance by the patient's nurse of the patient's physicians due to difficult placement, then it should be entered into Qpath as a training study, "TRAIN - US GUIDED NEEDLE PLACMENT".
If the patient was found to be a "difficult stick" or the nurses were unable to find an IV themselves and are now requesting ultrasound assistance, then an order should be placed for a "POC ED GUIDE VASCULAR ACCESS," and the study should be pulled up through the worklist on the machine.
As a student, you are unable to place orders, so it should be placed by the treatment team.
You will still need to be observed by a resident or an attending regardless of study type.
Point-of-care report
Point-of-care report
There is often confusion on how to fill out the report on a point-of-care vascular access study in Qpath.
The first option shown here implies that ultrasound was used to locate the vessel, but that it was not used during the procedure. This is a "static" method. where the probe was put down, and the line placed without active guidance.
The second option shown describes a line placed with "dynamic" visualization of the needle tip being "walked" into the vessel. This is how 99% of our lines are placed in the emergency department, and should be the button you select in general.
It is also generally recommended to type in what length & size of catheter was placed in the "Other Interpretation / Complication" section.
The "training" version of this report is blank, and all field need to be filled out manually. This is due to the training version being a catch-all procedural study, including paracentesis, thoracentesis, etc,. in addition to vascular access. Refer to the appropriate point-of-care report for appropriate templates to utilize to fill in the fields on this training report.
Failed lines & "blown" IV's
Failed lines & "blown" IV's
Some attempts at IV placement may fail, or may initially be successful but then suffer catheter failure soon after.
These should still be logged with images saved for review & documentation purposes.
These should still be logged with images saved for review & documentation purposes.
However, you should also make the nurses and physicians caring for the patient immediately aware of your failed attempt.
Apply direct pressure over the failed site.
Inform the nurses and physicians caring for the patient where on the patient's body the failed attempt was.
A failed IV at one site means that attempting to place another IV distally ("below") that failed site is dangerous, for if a successful line is placed distally, then the medications given may travel up to the "blown" site and extravasate into the surrounding tissue. Therefore, the patient's providers need to know where your line was attempted before they attempt again themselves.
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