Ultrasound guided vascular access and deep access PVC.

[Pontus Johansson]

Dear all!

Do you on your ward routinely use US-guidance for putting PVC, PICC-line in and if so do only doctors do it and/or nurses? Experience?

Also, any experience on so called "deep access canula" 32 mm vs 19 mm. Do they last longer? Any problems?

[Tamimi]

Thank you for bringing up the topic that is very dear to me. Yes we routinely use ultrasound for ECC insertion and peripheral arterial line. We use every now and then if the nurses are not able to secure a peripheral access.it’s done by a doctor in the unit that is interested in vascular access. Trainees are still learning it and it’s very steep learning curve although looks in theory very simple.

 

 

In regards to the access that you’ve posted. Yes I have experience with it with it. It was not good. In theory it sounds very appealing, but in reality, the metal cannula is soft and kind of pliable. I noticed that once I prick the skin and I have the needle under the skin and I tried to maneuver it left and right it bends I think because of the length that makes it bendable . But that’s my personal experience. I haven’t read any literature about this. I hope this helps.

[Terry]

Hi,

Currently work in Melbourne, Australia.

US guided cannulation is being used with increasing frequency in paediatrics and anaesthesia.  My experience with neonates is more limited, I've only really done it with supervision.  As Tamimi states, the learning curve is steep- it's like going back to square one all over again.  It's harder in neonates than with children I think, I feel like I need an extra arm.  You do need a longer cannula, with the shorter one you run out of road.  On the flipside, a 3cm line should stay in longer than a 1.9cm line.

Unrelated to ultrasound- we have on occasion used a guidewire to upgrade a 1.4cm line, or a 26g cannula to a 24g 3cm cannula.

[Francesco Cardona]

Hi Pontus,

agree with all comments before.

we have lots of experience with US-guided central lines, less with peripheral (but some) and arterial lines. It is only done by doctors at our department. We use both approaches: out-of-plane and in-plane.

Regarding the canulas: we use both, most commonly we use the neoflon/venflon. but personally I think the one on the left is superior as it is a lot sharper and has less issues with not being able to puncture the skin or vessels adequately. Though my favourite is the Jelco iv. Once you use it you dont want to go back - especially in kids with thicker/tougher skin. Although it needs some practice as it does not have the "wings" of the neoflon which allows for a better grip.

We have some experience with the guidewire, it comes in handy at times, but needs some practice to handle optimally.

Although aimed at adults, I think this article has lots of good practical advice: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9886173/  or also here https://www.pocus101.com/ultrasound-guided-peripheral-iv-insertion-placement-and-access-made-easy/

[Pontus Johansson]

Thank you all for very valuable input that also gives us and especially the nurse in question who knows this and is the only one so far doing it motivation to proceed with this, trying to educate others. We´ve tried US guided UVC and UAC on occasion and could definately get better there. We still x-ray for position. Really grateful for your help!

[Gustaf Lernfelt]

I would tag in @Roland in this topic aswell. As an ANNP and an ultrasound guided vascular access-expert, he will be able to provide you with all the information you need. https://99nicu.org/meetup/speakers/roland-van-rens/

[Roland NNP]

Thank you for this valuable discussion. From my experience, ultrasound-guided vascular access has significantly improved precision and reduced complications. But there is more……..

Establishing dedicated vascular access teams is essential, not only to ensure the highest level of expertise but also for continuity and quality of care.

Additionally, we need to realize not all catheter plastics are the same—PUR and PTFE (both plastics) have distinct properties. Arterial catheters differ from short peripheral ones, and with larger diameter catheters, the catheter-to-vessel ratio must be carefully assessed.

It’s always a complex challenge balancing skills, knowledge, available materials, and methods to optimize patient outcomes.

[Dr talal]

The advantages of ultrasound-guidance in vascular access are first-pass success, which is less attempts time taken to achieve intravenous access, high patient satisfaction, reduction in puncture attempts, and complications, and cost in cases. Furthermore, it has been shown that the use of ultrasound guidance will minimize the chances of bleeding and nerve injury as well.