ED nurses use ultrasound to place difficult IV lines

In 5 years, 50% of EDs may use them

Imagine a woman in sickle cell crisis coming to you crying and writhing in pain. Now imagine being unable to start intravenous (IV) access for more than two hours, with the IV finally being placed in her lower calf after multiple sticks.

This once-common scenario is now a thing of the past, reports Garry Thompson, RN, CEN, ED nurse at Medical College of Georgia in Augusta, where ED nurses now have a new tool to turn to: Ultrasound used to guide IV placement for difficult-access patients.

If you’re not using ultrasound currently in your ED, that may change soon. Although about 1,500 EDs currently are using ultrasound, nurses are performing ultrasound only at a handful of those, predicts Michael Blaivas, MD, RDMS, chief of emergency ultrasound at Medical College of Georgia. "I would say that in five years, up to 50% of those EDs will have nurses using ultrasound," he says.

Approach hospital administrators with compelling new research showing that ultrasound used by ED nurses can improve patient care and throughput, and decrease morbidity and potentially even mortality, urges Blaivas.1

The benefit is blood is obtained earlier for tests, and IV medications can be given faster in difficult stick patients, he says.

"In the past, nurses tried multiple times to get blood or place an IV. They would get other nurses to try and eventually look for one of the residents or attendings. They would spend a long time getting us out of other rooms or procedures."

If the physician could not get an IV at that point, a central line might be needed, adds Blaivas. "All of this took time, and occasionally blood work or antibiotics would be delayed by hours," he says.

With the use of ultrasound, now ED nurses can get in the vast majority of lines without assistance, says Blaivas.

"Patients are happier as they are stuck less and get their care faster," he says. "They typically do not know that they have been saved a central line, but central lines are responsible for considerable morbidity in this country, ranging from hematomas to pneumothorax and deep vein thrombosis."

Training consists of a 45-minute lecture given by Blaivas and a two-hour hands-on demonstration with an inanimate model simulating a human arm. An instructor then proctors nurses through their first few ultrasound-guided IVs. About half of the ED’s 50 nurses have been trained so far, and eventually all nurses will be trained, says Blaivas.

If nurses don’t get access after one stick, ultrasound usually is the immediate next step, says Thompson.

"If I’m having a hard time, I’ll just go right to the machine instead of hunting for veins on the legs," he says.

In addition, for patients likely to have difficult access, such as sickle cell patients, chemotherapy patients, patients on renal dialysis, obese patients, diabetics, and IV drug users, nurses can go right to ultrasound, says Thompson.

"We have a lot of sickle cell patients that require IV access. It would normally take us 30-45 minutes to get a line in those folks, but now we’ll automatically use the machine," he says. "Most of the time, we’ll get it on the first stick vs. constantly sticking the patient."

Reference

1. Brannam L, Blaivas M, Lyon M. Emergency nurses utilization of ultrasound guidance for placement for peripheral intravenous lines in difficult access patients. Acad Emerg Med 2004; 11:1,361-1,363.

Sources

For more information on ED nurses and ultrasound, contact:

  • Michael Blaivas, MD, RDMS, Chief, Section of Emergency Ultrasound, Department of Emergency Medicine, Medical College of Georgia, 1120 15th St., AF-2039, Augusta, GA 30912-4007. Telephone: (706) 721-2613. Fax: (706) 721-7718. E-mail: blaivas@pyro.net.
  • Garry Thompson, RN, CEN, Emergency Department, Medical College of Georgia, 1120 15th St., AF-2039, Augusta, GA 30912-4007. Telephone: (706) 721-4951. E-mail: gthompso@mcg.edu.