10 Verify Your Success
After you have placed an intravenous catheter, there are several ways to assess the integrity of your IV line. Little to no resistance when flushing the line with saline may be a good indicator that placement is correct. However, this may be unreliable. Good blood return may be a better sign that it is in place, but if there is any doubt, simply flush the line with saline under direct visualization with ultrasound. If catheter placement was successful, you will see turbulence inside of the vein when flushing with saline, as seen in Figure 10. You should not see the saline leaking into the surrounding tissues, creating edema. This is a sign of extravasation and line insertion failure.
- Costantino TG, Parikh AK, Satz WA, et al. Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access. Ann Emerg Med. 2005;46:456-61.
- Doniger SJ, Ishimine P, Fox JC, et al. Randomized controlled trial of ultrasound-guided peripheral intravenous catheter placement versus traditional techniques in difficult-access pediatric patients. Pediatr Emerg Care. 2009;25:154-9.
- Gregg SC, Murthi SB, Sisley AC, et al. Ultrasound-guided peripheral intravenous access in the intensive care unit. J Crit Care. 2010;25:514-9.
- Stein J, George B, River G, et al. Ultrasonographically guided peripheral intravenous cannulation in emergency department patients with difficult intravenous access: a randomized trial. Ann Emerg Med. 2009;54:33-40.
- Egan G, Healy D, O’Neill H, et al. Ultrasound guidance for difficult peripheral venous access: systematic review and meta-analysis. Emerg Med J. 2013;30:521-6.
- Kule A, Hang B, Bahl A. Preventing the collapse of a peripheral vein during cannulation: an evaluation of various tourniquet techniques on vein compressibility. J Emerg Med. 2014:46:659-66.
- Witting MD, Schenkel SM, Lawner BJ, et al. Effects of vein width and depth on ultrasound-guided peripheral intravenous success rates. J Emerg Med. 2010;39:70-5.
- Elia F, Ferrari G, Molino P, et al. Standard length catheters vs long catheters in ultrasound guided peripheral vein cannulation. Am J Emerg Med. 2012;30:712-6.
Dr. McNamee is chief resident of the emergency medicine residency at St. Joseph’s Regional Medical Center in Paterson, New Jersey.
Dr. Jeong is an emergency medicine resident at St. Joseph’s.
Dr. Patel is associate program director, emergency medicine, at St. Joseph’s.
Innovations: Better, Faster, Smarter
Do you have an out-of-the-box performer in your ED? ACEP Now is accepting submissions. Send 500 words describing your innovator and how they stand out from the pack to firstname.lastname@example.org.