When performing cannulation or blood draw, attempting venous access repeatedly without success can be extremely frustrating for both patient and medic. This situation is often caused by inhibiting factors such as dehydration, obesity, edema, and fragile veins.
But thanks to the coming of portable ultrasound devices, peripheral IV access has become less stressful. Clinicians can perform ultrasound-guided IV insertion (USG-IV insertion) with more ease, visualizing veins in real time.
What's more, ultrasound guided vascular access has high first-attempt rates. And that reduces the number of punctures and enhances safety in blood draw and cannulation procedures.
In this post, we demonstrate with a real video how needle insertion, needle-tip tracking, and confirmation of successful cannulation are made easier by ultrasound guided vascular access using a DRSONO portable ultrasound device.
Ultrasound-guided venous access is a procedure that uses ultrasound imaging to help clinicians visualize veins beneath the skin, then safely and successfully insert a needle into a blood vessel.
We know that traditional visual vessel inspection and palpation are effective for patients with easily visible veins.
However, these methods are less successful in patients with deep, fragile, and poorly palpable veins. In such cases, ultrasound guided IV access is a true game-changer, providing an extra layer of procedural accuracy.
So, exactly how does venous access ultrasound guidance work?
During an ultrasound-guided venipuncture, the probe is placed over the target area to identify suitable veins for puncture.
From the ultrasound image, clinicians can assess:
This broad-vasculature image significantly reduces first-attempt failures and helps you select the best vein for IV insertion.
You can observe all those details in this video.
Notice how the doctor uses the ultrasound to:
But, exactly how does ultrasound imaging optimize IV access?
One of the major advantages of ultrasound guided PIV placement is that you can see the needle advancement. Not having to place the catheter blindly helps you monitor the needle tip in real time as it enters the lumen.
Why is this important?
Because experts consider it one of the key principles of safe vascular access. With real-time imaging, you can:
In the demonstration video, you can see how the needle tip remains visible during the entire procedure. This helps with accurate entry into the vein. The doctor is also able to confirm successful venous cannulation as soon as access is achieved.
All this highlights the specific reasons why more and more healthcare practitioners are adopting ultrasound guided IV insertion.
Recent research suggests that ultrasound-guided peripheral IV catheter insertion is becoming standard practice, especially with pediatric patients and difficult adult cases.
The reasons are obvious.
First, it is a lot more efficient than traditional palpation and visualization. Besides, there are several advantages of ultrasound guided IV access:
Studies have shown that venous access ultrasound guidance significantly increases first-time IV access success rates by up to 95%.
That’s because clinicians can easily select veins with.
In the demonstration video, you can hear when the doctor identifies a “massive, very compressible vessel” with an appropriate diameter. She also points to 2 adjacent arteries that should be avoided. Without the ultrasound, those details are hard to notice.
When IV insertion is guided by ultrasound, clinicians take less time to perform the procedure. It also reduced the number of insertion attempts. That prevents issues such as hemolysis and patient discomfort.
A étude with difficult IV access patients found that using ultrasound reduced cannulation time to only 6 minutes, compared to 11 minutes using the traditional methods. Other studies have reported even shorter times.
Some patient populations are especially likely to benefit from ultrasound guided IV placement. They include:
By helping clinicians locate deeper peripheral veins that are not visible externally, ultrasound imaging makes vascular access more successful in patients who would otherwise require escalated procedures, such as central venous catheter placement.
Ultrasound helps you pick the right vein and enhances insertion precision. That means that it also ensures longer catheter dwell time.
A étude found that ultrasound-guided IV insertion had a dwell time ranging from 1 to 80 days. It also increased treatment completion rate with a single catheter by over 80%.
Evidence from some of the studies we’ve already mentioned shows that ultrasound-guided venous access has significantly greater patient satisfaction. That’s because:
Ultrasound-guided venipuncture benefits also increase staff satisfaction and improve workflow.
In our reference video, you definitely heard the doctor posing as a patient when he said, “I'm actually surprised at how unpainful that was.”
So, how do you do ultrasound-guided IV placement step-by-step?
Successful ultrasound guided IV placement is achieved in a 3-step procedure:
The clinician uses the probe to identify an appropriate target vein. They do this by evaluating the anatomy of the target area and the surrounding tissue and vessels.
As mentioned earlier, the clinician will determine the right vessel based on factors such as vein diameter and depth, compressibility, vessel straightness, and distance from arteries and valves.
This assessment process is excellently demonstrated in the reference video. The doctor can see the target vein clearly before proceeding to puncture.
Once the vein has been identified, the clinician advances the needle under continuous ultrasound guidance. This is one of the key aspects of ultrasound guided venipuncture: maintaining visualization of the needle tip throughout advancement.
By so doing, the clinician can:
The clinician can choose to perform the procedure using:
Short axis or out-of-plane describes the IV insertion where the focus is on the surrounding tissues. The target vein appears as a circle, and the clinician targets the center of that circle.
Out-of-plane IV insertion has higher success rates. It is easier for beginners and has a lower risk of missing the vessel when targeted horizontally.
However, it is harder to track the needle tip with this method, implying greater risks of punctures on the posterior wall.
Choose it to access deep veins or for rapid localization.
Long axis, or in-plane IV access, visualizes the entire needle tip. The vein is seen as a long linear structure. For that reason, it has a lower risk of posterior wall punctures.
As a disadvantage, in-plane ultrasound IV insertion is harder to keep the needle in the exact narrow plane, which increases the risk of proceeding lateral to the vein.
Use the long axis technique when you want to keep off the posterior walls and obtain a precise catheter angle.
In summary, both short-axis and long-axis are effective IV insertion procedures. But the first is preferred for its ease.
In the demonstration video, the clinician primarily uses a short-axis (out-of-plane) ultrasound approach, allowing cross-sectional visualization of the target vein during needle advancement. She can see the vein in cross-section and the needle as a bright dot (“bullseye”) entering the vessel, instead of a full shaft along its axis.
Procedurally, this means:
Once the needle enters the vein successfully, ultrasound imaging helps confirm proper vessel access before completing catheter advancement.
Real-time imaging will demonstrate:
This confirmation is especially valuable in patients with difficult venous access, where traditional visual cues may be less reliable.
In the reference video, the doctor confirms successful venous cannulation, which she can visualize during the procedure. In this case, she does not need to rely on blood return to verify accurate placement.
It’s worth mentioning here that portable wireless ultrasound systems have made bedside vascular access and workflow more effective.
Because portable handheld ultrasound scanners connect directly to your smartphone, tablet, or iPad, clinicians can carry them from room to room or department to department without needing to depend on the traditional large, cart-based ultrasound systems.
They can also perform vascular access procedures more efficiently in emergency and critical care units.
For example, the DRSONO Tri-max scanner used in the demonstration video is a portable device that is lightweight and has a long-lasting battery, making it perfect for use in emergency and bedside settings.
Because it is also wireless and connects to a mobile gadget, the doctor performs vascular access without relying on a cart-based system.
Besides, it is a more cost-effective option than the cart-based system. And compared to other portable ultrasound scanner brands, it does not require annual subscription fees, making it an optimal option for long-term use.
With all we’ve said so far, you can tell that venous access ultrasound guidance is a procedure that requires precise skills. And that implies the need for training.
Because bedside ultrasound is becoming more widely used in vascular access, many healthcare facilities are investing in ultrasound guided IV insertion training for nurses.
The reason is obvious.
Nurses play a crucial role in peripheral IV placement, ultrasound guided blood draws, and bedside patient care. As such, ultrasound-guided venous access is a valuable clinical skill for them.
Learning to perform ultrasound guided IV insertion is more than basic venipuncture techniques.
Nurses also need to have basic ultrasound interpretation skills, probe handling techniques, and hand-eye coordination during real-time needle guidance.
Here’s a quick run-through of the key components of USGPIV Training for nurses:
This includes acquiring skills related to:
A good understanding of ultrasound anatomy is key because vessel appearance can vary significantly depending on patient characteristics and probe positioning.
This includes skills in mastering probe orientation and fanning. Nurses learn to hold the probe in a transverse and longitudinal view and identify veins in each view.
Nurses acquire skills on how to perform IV insertion using the short-axis or long-axis options.
In the video, you can hear the doctor identifying the vein as a very sharp white line and the needle tip as a bull’s eye.
This skill is about learning to move the probe and needle simultaneously. It ensures accuracy or dynamic needle tip positioning.
This part of the training entails learning to insert the IV at the right angle (45 degrees). It could also be a steeper angle when deep veins are the target, then lowering it once the puncture is achieved.
In addition to these skills, nurses also learn to maintain sterile technique during scanning. You can clearly see how the doctor practices this crucial aspect of IV placement in the demonstration video.
Besides, the nurses get to perform simulation and real-world practice of IV placement. In this case, training institutions incorporate:
In all this, portable ultrasound scanners are a perfect option for training, providing greater access for both trainers and trainees.
Ultrasound guided venous access has become a valuable technique for improving IV placement accuracy. Using real-time visualization, clinicians can ensure efficient ultrasound guided PIV insertion with a higher first-attempt success rate and patient comfort.
The demonstration video in this article has shown how continuous ultrasound guidance during IV placement supports safer and more controlled peripheral vascular access at the bedside. And all that with an affordable, portable handheld ultrasound device that one can carry in their lab coat for use across emergency, critical care, and other patient care settings.
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