Abstract
Peripheral intravenous line placement is a common procedure in emergency medicine. Ultrasound guidance has been demonstrated to improve success rates, as well as decrease complications and pain. This paper provides a narrative review of the literature focusing on best practices and techniques to improve performance with this procedure. We provide an evidence-based discussion of preparation for the procedure, vein and catheter selection, multiple techniques for placement, and line confirmation.
Highlights
After the first reported use of ultrasound for real-time central venous catheter (CVC) insertion was reported in 1984,1 ultrasound-guidance progressively became the standard approach for placement, when cannulating the internal jugular vein.[2,3]
As ultrasound technology and training have improved, researchers have studied whether the benefits of ultrasound in central venous access would translate to peripheral intravenous line (PIV) placement
In cases where a longer catheter with a guidewire is not available, Mills et al describe a different technique by which initial access is obtained and the PIV is replaced with a longer, more sustainable PIV, using a guidewire for catheter exchange.[57] of this technique is that the entire needle is visualized, thereby reducing the risk of posterior wall injury, while ensuring that sufficient length of catheter has entered the vein for successful advancement
Summary
After the first reported use of ultrasound for real-time central venous catheter (CVC) insertion was reported in 1984,1 ultrasound-guidance progressively became the standard approach for placement, when cannulating the internal jugular vein.[2,3] When used for CVC insertion, ultrasound guidance has led to increased placement success, decreased complication rates, and decreased insertion times.[4]. We provide an evidence-based discussion of preparation for the procedure, vein and catheter selection, multiple techniques for placement, and line confirmation.
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