What is intravenous (IV) guided ultrasound?

From the Guidelines

IV guided ultrasound is recommended for patients with difficult venous access, as it improves first-attempt success rates, reduces complications, and decreases patient discomfort. This approach is particularly useful for patients who are obese, dehydrated, have a history of IV drug use, or have undergone multiple previous IV attempts. The procedure involves using a portable ultrasound device to visualize veins beneath the skin, allowing clinicians to identify suitable vessels, assess their depth and diameter, and avoid nearby structures like arteries or nerves 1.

Benefits of IV Guided Ultrasound

• Improves first-attempt success rates (typically 80-90% versus 50-60% with traditional methods) 1
• Reduces complications like infiltration or hematoma formation
• Decreases patient discomfort
• Saves time in emergency situations
• Requires specific training but has become standard practice in many emergency departments, intensive care units, and other clinical settings where difficult IV access is common

Evidence Supporting IV Guided Ultrasound

• A meta-analysis of 311 patients demonstrated a 71% improvement in first-pass success rate with ultrasound guidance versus the palpation technique 1
• A study comparing real-time ultrasound guidance with the traditional palpation method revealed that successful cannulation was greater in the ultrasound group (97%) than in the control group (33%) 1
• The use of ultrasound guidance is recommended for both short-term and long-term central venous access, as it reduces the risk of catheter contamination and catheter-related infection 1

Recommendations for IV Guided Ultrasound

• The use of ultrasound dynamic guidance (instead of the landmark technique) may improve the success rate and diminish complications during peripheral venous and arterial cannulation 1
• Ultrasound guidance is recommended for patients with difficult venous access, particularly those who are obese, dehydrated, have a history of IV drug use, or have undergone multiple previous IV attempts 1

From the Research

IV Guided Ultrasound

• IV guided ultrasound is a technique used to improve the success rate of peripheral intravenous catheter placement, especially in patients with difficult venous access 2, 3, 4, 5, 6.
• The use of ultrasound guidance for peripheral intravenous catheter insertion has been shown to increase the first attempt success rate and reduce the number of attempts required for successful placement 4, 5, 6.
• Studies have demonstrated that ultrasound-guided peripheral intravenous catheter placement is associated with a higher success rate compared to the standard of care palpation technique 4, 5.
• The use of ultrasound guidance has also been shown to reduce the pain score for patients undergoing peripheral intravenous catheter insertion 6.
• A clinical pathway for the management of difficult venous access using ultrasound guidance has been developed and implemented in some institutions, with reported success rates of 93% for first attempt insertion 6.

Benefits of IV Guided Ultrasound

• Increased first attempt success rate for peripheral intravenous catheter placement 4, 5, 6.
• Reduced number of attempts required for successful placement 4, 5, 6.
• Lower pain scores for patients undergoing peripheral intravenous catheter insertion 6.
• Reduced risk of complications associated with central venous catheter placement 2, 3.

Clinical Applications

• IV guided ultrasound can be used in various clinical settings, including emergency departments and inpatient wards 2, 3, 4, 5, 6.
• The technique can be used to improve the management of patients with difficult venous access, reducing the burden of multiple painful attempts at cannulation and anxiety 6.