Ultrasound guided canulation as the new gold standard for IV access. Peter Ouden

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Any medical professional with hospital experience knows how crucial successfully inserting a peripheral IV can be. Getting fluids and medications without delays, into a critically ill or injured patient can make or break the effectiveness of their treatment.
Vascular access for the infusion of medications and solutions requires timely assessment, planning, insertion, and assessment. Traditionally vascular access is reactive, painful, and ineffective, often resulting in the exhaustion of peripheral veins prior to consideration of other access options.
At best, a patient with challenging vasculature that involves multiple insertion attempts can frustrate and fluster medical staff while causing the patient to experience pain. At worst, a tricky vein can mean mounting medical complications as a patient condition worsens; and the eventual necessity of a central venous line, which while remarkably effective, carries its own set of risks.
Multiple attempts at cannulation and the placement of IV devices in areas such as the wrist and anti-cubital fossa can increase the risk of thrombosis, infection, and device failure.
“[It] can cause anxiety, patients can develop phobias,” says Dr Evan Alexandrou of Liverpool Hospital in New South Wales, Australia. “They come to us highly anxious, sometimes crying, and they’re essentially at the point of refusing any treatment because of the trauma.”
Veins can be difficult to access for several reasons, such as patient dehydration, a history of previous multiple canulations, including attempts, intravenous drug use, and obesity. Underweight and premature infants are particularly difficult candidates for normal peripheral IV access because their veins are simply so small.
Given the necessity and prevalence of peripheral IVs as a part of treatment, it is no wonder that any solution that would make IV access easier would be eagerly adopted in almost any setting.
Introducing ultrasound guided IV insertion to patients with challenging vasculature is exactly what is happening at Christchurch Hospital. Spearheaded by the Department of Radiology Nursing Team a new protocol for limiting the number of failed IV insertion attempts is now being adopted by other teams within the hospital campus.
Evidence suggests clinical pathways improve outcomes by reducing variations and establishing processes to assess and coordinate care, minimizing fragmentation and cost. Implementation of a vascular access clinical pathway will lead to the intentional selection of the best vascular access device for the patient specific to the individual diagnosis, treatment plan, current medical condition, and the patient’s vessel health. A Vessel Health and Preservation (VHP) programme incorporates evidence-based practices focused on timely, intentional proactive device selection implemented within 24 hours of admission into any acute facility.

Aim/Objectives: The learning objectives for this presentation are:

  • Early identification of the Difficult IV Access (DIVA) patient
  • Early identification and insertion of the correct IV access device
  • Ultrasound Guided Cannulation as the new Gold Standard for vascular access

Peter gained his Nursing Registration in 2001 and joined the Canterbury District Health Board soon after. After completing the New Graduate program, he joined the Orthopedics nursing team, where the Charge Nurse was very proactive in encouraging her nurses into post-graduate studies. He completed two Post-Graduate Certificates (Health Sciences Endorsed in (High Dependency Nursing) through University of Otago and Clinical Teaching through University Canterbury) in this time.
In 2009 Peter joined the Radiology Nursing team, a steep learning curve going from Orthopedics to theatre nursing, he loved it.
2011, he completed the PICC learning package, and has not looked back, since then he advanced into Paediatric PICC insertion and tunneled PICC lines.
His passion and skills have also led me to become very competent at using an ultra-sound to place an IV line, especially those with difficult IV access (DIVA).
He enjoy teaching especially one on one, whether it is focused on ultrasound canulation or passing on skills learned with adult PICC insertions too the next generation of vascular access nurses.