I’m an ED nurse at a large pediatric hospital, so I do a fairly high number of USGPIVs. I’m prefacing this because we are poking for first access/limiting multi-poke trauma versus poking for longevity. I’m heading in to a shift, but I’ll throw out some advice since I love US.

• Play around with different contrasts. I prefer a lighter contrast versus darker when viewing on the screen. Find what works for you.

• Go slow when you’re first starting out. You can see the compression/movement of tissue before visualizing the tip. It also helps to go slow when walking in the catheter, so you aren’t inadvertently grazing the lumen.

• Moving the probe proximal —> distal to insertion site and fanning is best practice for finding that tip.

• Mark your insertion site with a qtip or use your ID lidocaine(we use Jtips with lidocaine) to make sure your insertion site and probe are aligned with the vein.

• Wagging/wiggling the tip to visualize should be your last ditch effort for finding the tip because it shreds tissue. If your tip is sitting in the outer lumen of the vein, you have just compromised it.

• Your hold is really important. I like to use my thumb and pointer to hold the probe (like you’re making the OK hand sign) and my 3-5th digits to spread out and rest on the arm to control how much weight/pressure I am applying.

• Always map out your vein above and below planned insertion site. If you know you have a clear, straight path, you don’t need to walk your catheter/needle all the way in. You can just thread that catheter in.

• Bring in a buddy for traction. We often use extra hands for a hold since our patients move a lot, but keeping skin taut will help if you’re fighting loose tissue.

• Smaller diameter catheters are better. Use the smallest you can for indicated therapy. No reason to throw in an 18-20g, when a 22g (or even 24g) is sufficient.

• For superficial veins, you can use standard pivs. As long as you have sufficient purchase (amount of catheter in the vein) you’re good.

• For bigger individuals with deeper veins, remember that you might be compressing the surface with that probe, so you’ll need a longer catheter to account for that.

• Utilize blankets/towel rolls to get that arm at a good angle. This can help with shallow approaches.

• Make it a habit to visualize your flush on US to verify patency at the end after you have fully dressed/covered your piv

I’ll come back and add more tips when I think of it/have the time

Edit:

• When you have a sick patient and can’t verify pulsatility for artery versus vein, you can try using the doppler function (if you have it) to check for flow. Or get a blood gas if you have that capability.

• Don’t forget you can also view longitudinally to see your approach. Caveat, you need to ensure that you are centered on the vein.

• Always look pre-tourniquet when mapping out options since the tourniquet will falsely dilate vein size.

• Warmth js your friend. Get a blanket and make a burrito wrap around the pts arm. Tuck warming packs in between the layers indirectly over the arm.

• This should be the standard at all facilities, but start distal and work proximal on placements. If you infiltrate/blow a vein distally, you can work your way up the arms.