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David Plummer - One of the best experts on this subject based on the ideXlab platform.
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ultrasound guided peripheral IV Placement
The New England Journal of Medicine, 2012Co-Authors: Scott Joing, Seth R Strote, Liberty V Caroon, Christopher Wall, Jamie Hess, Chad Roline, Ben Dolan, Robb Poutre, Kathleen Carney, David PlummerAbstract:Placement of peripheral intravenous (IV) catheters is a fundamental skill that all health care professionals should possess. Unfortunately, it can be difficult to obtain IV access in some patients, including obese patients, children, and patients who have undergone Placement of many IVs or who have a history of difficult IV access. Ultrasound guidance enables visualization of veins that are not apparent on physical examination, resulting in fewer needlesticks, more rapid cannulation, and less discomfort in patients with difficult IV access. 1-3 Ultrasound-guided IV Placement is indicated when it is difficult or impossible to use traditional techniques. There is no contraindication to ultrasound-guided IV Placement, but it is unnecessary when traditional techniques are sufficient. Health care providers who are proficient in standard Placement techniques will find it relatIVely easy to learn ultrasound-guided techniques. There are two common approaches to the position of the transducer during ultrasound-guided Placement of IV catheters: transverse and longitudinal. The transverse approach is easier to learn, but the longitudinal approach is preferred by many experienced providers because it allows better visualization of the needle. 4,5 It is best to learn both techniques. Potential cannulation sites are the hand, the antecubital veins of the forearm, and the basilic, cephalic, and brachial veins of the upper arm. Preparation To get started, wash your hands, adhere to unIVersal precautions, clean the ultrasound transducer with a germicidal solution, place a tourniquet, and apply sterile gel or surgical lubricant to the transducer. Adjust the gain and depth settings of the ultrasound system so that vessels appear black and are in the center of the ultrasound image. Find an appropriate vein by scanning the arm in the transverse orientation, which provides a cross-sectional view of the anatomy and allows simultaneous visualization of veins, arteries, and other structures (Fig. 1). Vessels appear as circular structures, and veins are easily distinguished from arteries because veins collapse with compression. When choosing a vein, remember that a vein with a relatIVely large diameter is more likely to result in successful catheterization. The depth of a vein is not as important as its diameter, but longer IV catheters are needed for veins that lie more than 1 cm from the surface of the skin. Standard IV catheters are 3.2 cm long (Fig. 2). Common sizes range from 24-gauge for newborns to 14-gauge for adult patients with trauma. Angiocatheters that are 6.4 cm long are adequate for cannulating vessels that are a maximum of about 2 cm from the surface of the skin. Specialized catheters may be best for cannulation of deeper veins. 24-gauge
Anthony J Dean - One of the best experts on this subject based on the ideXlab platform.
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what you see sonographically is what you get vein and patient characteristics associated with successful ultrasound guided peripheral intravenous Placement in patients with difficult access
Academic Emergency Medicine, 2009Co-Authors: Nova Panebianco, Jenna M Fredette, Demian Szyld, Emily B Sagalyn, Jesse M Pines, Anthony J DeanAbstract:ObjectIVes: Ultrasound (US) has been shown to facilitate peripheral intravenous (IV) Placement in emergency department (ED) patients with difficult IV access (DIVA). This study sought to define patient and vein characteristics that affect successful US-guided peripheral IV Placement. Methods: This was a prospectIVe observational study of US-guided IV Placement in a convenience sample of DIVA patients in an urban, tertiary care ED. DIVA patients were defined as having any of the following: at least two failed IV attempts or a history of difficult access plus the inability to visualize or palpate any veins on physical exam. Patient characteristics (demographic information, vital signs, and medical history) were collected on enrolled patients. The relationships between patient characteristics, vein depth and diameter, US probe orientation, and successful IV Placement were analyzed. Results: A total of 169 patients were enrolled, with 236 attempts at access. Increasing vessel diameter was associated with a higher likelihood of success (odds ratio [OR] = 1.79 per 0.1-cm increase in vessel diameter, 95% confidence interval [CI] = 1.37 to 2.34). Increasing vessel depth did not affect success rates (OR = 0.96 per 0.1-cm increase of depth, 95% CI = 0.89 to 1.04) until a threshold depth of 1.6 cm, beyond which no vessels were successfully cannulated. Probe orientation and patient characteristics were unrelated to success. Conclusions: Success was solely related to vessel characteristics detected with US and not influenced by patient characteristics or probe orientation. Successful DIVA was primarily associated with larger vessel, while vessel depth up to >1.6 cm and patient characteristics were unrelated to success. Clinically, if two vessels are identified at a depth of <1.6 cm, the larger diameter vessel, even if comparatIVely deeper, should yield the greatest likelihood of success. ACADEMIC EMERGENCY MEDICINE 2009; 16:1298‐1303 a 2009 by the Society for Academic Emergency
Scott Joing - One of the best experts on this subject based on the ideXlab platform.
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ultrasound guided peripheral IV Placement
The New England Journal of Medicine, 2012Co-Authors: Scott Joing, Seth R Strote, Liberty V Caroon, Christopher Wall, Jamie Hess, Chad Roline, Ben Dolan, Robb Poutre, Kathleen Carney, David PlummerAbstract:Placement of peripheral intravenous (IV) catheters is a fundamental skill that all health care professionals should possess. Unfortunately, it can be difficult to obtain IV access in some patients, including obese patients, children, and patients who have undergone Placement of many IVs or who have a history of difficult IV access. Ultrasound guidance enables visualization of veins that are not apparent on physical examination, resulting in fewer needlesticks, more rapid cannulation, and less discomfort in patients with difficult IV access. 1-3 Ultrasound-guided IV Placement is indicated when it is difficult or impossible to use traditional techniques. There is no contraindication to ultrasound-guided IV Placement, but it is unnecessary when traditional techniques are sufficient. Health care providers who are proficient in standard Placement techniques will find it relatIVely easy to learn ultrasound-guided techniques. There are two common approaches to the position of the transducer during ultrasound-guided Placement of IV catheters: transverse and longitudinal. The transverse approach is easier to learn, but the longitudinal approach is preferred by many experienced providers because it allows better visualization of the needle. 4,5 It is best to learn both techniques. Potential cannulation sites are the hand, the antecubital veins of the forearm, and the basilic, cephalic, and brachial veins of the upper arm. Preparation To get started, wash your hands, adhere to unIVersal precautions, clean the ultrasound transducer with a germicidal solution, place a tourniquet, and apply sterile gel or surgical lubricant to the transducer. Adjust the gain and depth settings of the ultrasound system so that vessels appear black and are in the center of the ultrasound image. Find an appropriate vein by scanning the arm in the transverse orientation, which provides a cross-sectional view of the anatomy and allows simultaneous visualization of veins, arteries, and other structures (Fig. 1). Vessels appear as circular structures, and veins are easily distinguished from arteries because veins collapse with compression. When choosing a vein, remember that a vein with a relatIVely large diameter is more likely to result in successful catheterization. The depth of a vein is not as important as its diameter, but longer IV catheters are needed for veins that lie more than 1 cm from the surface of the skin. Standard IV catheters are 3.2 cm long (Fig. 2). Common sizes range from 24-gauge for newborns to 14-gauge for adult patients with trauma. Angiocatheters that are 6.4 cm long are adequate for cannulating vessels that are a maximum of about 2 cm from the surface of the skin. Specialized catheters may be best for cannulation of deeper veins. 24-gauge
Albert Rizzo - One of the best experts on this subject based on the ideXlab platform.
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effectIVeness of virtual reality for pediatric pain distraction during IV Placement
Cyberpsychology Behavior and Social Networking, 2006Co-Authors: Jeffrey I Gold, Seok Hyeon Kim, Alexis J Kant, M Joseph, Albert RizzoAbstract:The objectIVe of this study was to test the efficacy and suitability of virtual reality (VR) as a pain distraction for pediatric intravenous (IV) Placement. Twenty children (12 boys, 8 girls) requi...
Denise M Dowd - One of the best experts on this subject based on the ideXlab platform.
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validation and refinement of the difficult intravenous access score a clinical prediction rule for identifying children with difficult intravenous access
Academic Emergency Medicine, 2011Co-Authors: Michael W Riker, Chris Kennedy, Brad S Winfrey, Kenneth Yen, Denise M DowdAbstract:ACADEMIC EMERGENCY MEDICINE 2011; 18:1129–1134 © 2011 by the Society for Academic Emergency Medicine Abstract ObjectIVes: The difficult intravenous access (DIVA) score, a proportionally weighted four-variable (vein palpability, vein visibility, patient age, and history of prematurity) clinical rule, has been developed to predict failure of intravenous (IV) Placement in children. This study sought to externally validate and refine the DIVA score. Methods: Patients undergoing peripheral IV Placement by pediatric emergency department (ED) nurses were enrolled. The outcome of interest was defined as failure of cannulation on first attempt. Proposed refinement predictor variables include history of newborn intensIVe care unit (NICU) stay, operator experience characteristics (years since graduation, years of pediatric nursing experience, and IVs started per month), and skin shade. Adjusted multIVariate models were constructed using logistic regression. ReceIVer operating characteristic (ROC) curves were constructed and areas under the curve (AUC) calculated for each model. Results: A total of 366 subjects were enrolled (mean age = 5.4 years, SD ± 5.6 years) and of them, 118 (32.2%) subjects failed the first IV attempt. The original four-variable model tested in this data set resulted in an AUC of 0.72 (95% confidence interval [CI] = 0.67 to 0.78). Patients with a DIVA score of 4 or greater had more than 50% likelihood of failed first IV attempt. A three-variable rule (vein palpability, vein visibility, and patient age) was evaluated and found to possess similar discriminating ability (AUC = 0.72, 95% CI = 0.67 to 0.78). Conclusions: This study validated the previously derIVed four-variable DIVA score. A simpler three-variable rule was as predictIVe of failed IV Placement on first attempt as the four-variable rule. Validation in nonpediatric EDs is needed to thoroughly evaluate generalizability.
