Ultrasound Guidance for IV Cannulation 

IV cannulation is a procedure used to introduce a catheter into an artery or vein. This can be completed in peripheral or central blood vessels of the body. Previously, IV cannulation has been completed without visual guidance, but methods including ultrasonography have been used to increase success rates of cannulation and decrease complications of “blind” IV cannulation. The first reported instance of ultrasound guidance being used for central venous catheter insertion was in 1984 (Gottlieb, et al., 2017). Literature supports that for both peripheral and central IV cannulation, ultrasound guidance improves placement success and decreases the number of attempts needed (Gottlieb et al., 2017). 

IV cannulation is important in various aspects of patient care including peripheral access in the emergency department, resuscitation in the critical care setting, and in the creation of arteriovenous fistulas for patients on dialysis (Luehr, 2018) (Gottlieb, et al., 2017). Furthermore, two-dimensional ultrasonography allows technicians to assess for anatomic variations and signs of vascular thrombosis when selecting a site (Franco-Sadud, et al., 2019).  

In a meta-analysis study comparing ultrasound guidance with traditional methods of peripheral IV cannulation in adult patients, it was found that ultrasound-guided peripheral cannulation was significantly more successful. It was found to be especially useful in patients who have had multiple failed attempts of “traditional” peripheral IV cannulation. It also reduced the number of attempts and time required to achieve IV cannulation. This therefore saved staff time and equipment use and decreased healthcare expenditure. While increasing the level of patient satisfaction, ultrasound guided IV cannulation did not result in fewer complications (van Loon, et al., 2018). These findings transfer to the pediatric population as well, especially in children with difficult IV access (Benkhadra, et al., 2012).  

To perform successful IV cannulation with ultrasound guidance, there are several steps that must be closely followed. Preparation involves gathering all appropriate supplies, accounting for any patient contraindications or relevant comorbidities, and setting up the ultrasound for the procedure. Sterilization measures must be taken to ensure that there is no infection from the catheter site. Next, the technician must find the most appropriate vein to cannulate. The ultrasound probe can be used to apply a small amount of pressure to distinguish if a vessel is a vein or an artery. The technician may also trace the course of the vessel with ultrasound. The most common technique to place a peripheral IV with ultrasound guidance is in the short-axis approach during which the vein is visualized cross sectionally. Other approaches include the long-approach and oblique-approach. Ultrasound is used in the long-axis view to confirm placement of a catheter in the vessel (Gottlieb, et al., 20117).  

Success with ultrasound guided IV placement depends on technician skill set and experience, not just image quality of the ultrasound machine (van Loon, et al., 2018). There is no current consensus on how many ultrasound-guided placements must be observed to determine competency. However, the procedure of ultrasound guidance to obtain peripheral IV cannulation is regarded as easy to learn (van Loon, et al., 2018). Some methods used to minimize loss of venous access include using longer catheters and advancing the entire IV with ultrasound. (Gottlieb et al., 2017).  

Ultimately, existing literature is very supportive that ultrasound-guided IV cannulation is recommended over the traditional approach of palpation or direct visualization cannulation when possible. There is still a set of guidelines that must be followed to decrease risk of infection, ensure success on the first attempt, and ensure that technicians are adequately trained in IV cannulation.  

References  

Benkhadra M, Collignon M, Fournel I, et al. Ultrasound guidance allows faster peripheral IV cannulation in children under 3 years of age with difficult venous access: a prospective randomized study. Paediatr Anaesth. 2012;22(5):449-454. doi:10.1111/j.1460-9592.2012.03830.x 

Franco-Sadud R, Schnobrich D, Mathews BK, et al. Recommendations on the Use of Ultrasound Guidance for Central and Peripheral Vascular Access in Adults: A Position Statement of the Society of Hospital Medicine. J Hosp Med. 2019;14(9):E1-E22. doi:10.12788/jhm.3287 

Gottlieb M, Sundaram T, Holladay D, Nakitende D. Ultrasound-Guided Peripheral Intravenous Line Placement: A Narrative Review of Evidence-based Best Practices. West J Emerg Med. 2017;18(6):1047-1054. doi:10.5811/westjem.2017.7.34610 

Luehr A. Use of Ultrasound Guidance During Cannulation of Arteriovenous Fistulas. Nephrol Nurs J. 2018;45(5):423-434. 

van Loon FHJ, Buise MP, Claassen JJF, Dierick-van Daele ATM, Bouwman ARA. Comparison of ultrasound guidance with palpation and direct visualisation for peripheral vein cannulation in adult patients: a systematic review and meta-analysis. Br J Anaesth. 2018;121(2):358-366. doi:10.1016/j.bja.2018.04.047