3:1:3 rule - look for veins that are a minimum 3 mm in diameter, 1 cm deep (1.5 cm max), 3 mm long (and straight)
Basilic vein and deep brachial are good targets for upper arm
External jugular in neck
If no suitable<unk>  veins or external jugular, can consider EZ IJ
Similar procedure as ultrasound guided IV but use a longer<unk>  ultrasound catheter and should only stay in for <24 hours, must obtain CXR to rule out pneumothorax
As a general rule the depth of the vein equals the distance from the probe at which you should enter the skin at a 45 degree angle
Basilic vein and deep brachial are good targets for upper arm
External jugular in neck
If no suitable<unk>  veins or external jugular, can consider EZ IJ
Similar procedure as ultrasound guided IV but use a longer<unk>  ultrasound catheter and should only stay in for <24 hours, must obtain CXR to rule out pneumothorax
Similar procedure as ultrasound guided IV but use a longer<unk>  ultrasound catheter and should only stay in for <24 hours, must obtain CXR to rule out pneumothorax
Can be done in cross-section, longitudinal section, or utilizing a combination of the two
Cross-section allows easier approach to the vein and works well for superficial veins in particular, but the user must be careful to find the needle tip at all times (by fanning the probe and seeing the needle tip disappear and then re-appear) because otherwise you may be looking at any point along the needle and not know where the tip is located; easy to go through back wall.
Longitudinal section allows good visualization of the vein and needle depth (to avoid back-walling), but it can be difficult to keep the needle tip in plan during the entire approach and for superficial veins it is difficult to find the needle before entering the vein
An effective combination of these two techniques involves gaining access to the vein in cross-section and then changing to longitudinal section to follow the needle into the vein and avoid going through back wall
It is important to not stop once you see flash in catheter. This should be your cue to switch to longitudinal section (if not already done) and continue to advance catheter at least several millimeters up to a centimeter further under visualization. Doing so will significantly increase success rate.
Cross-section allows easier approach to the vein and works well for superficial veins in particular, but the user must be careful to find the needle tip at all times (by fanning the probe and seeing the needle tip disappear and then re-appear) because otherwise you may be looking at any point along the needle and not know where the tip is located; easy to go through back wall.
Longitudinal section allows good visualization of the vein and needle depth (to avoid back-walling), but it can be difficult to keep the needle tip in plan during the entire approach and for superficial veins it is difficult to find the needle before entering the vein
An effective combination of these two techniques involves gaining access to the vein in cross-section and then changing to longitudinal section to follow the needle into the vein and avoid going through back wall
It is important to not stop once you see flash in catheter. This should be your cue to switch to longitudinal section (if not already done) and continue to advance catheter at least several millimeters up to a centimeter further under visualization. Doing so will significantly increase success rate.
It is important to not stop once you see flash in catheter. This should be your cue to switch to longitudinal section (if not already done) and continue to advance catheter at least several millimeters up to a centimeter further under visualization. Doing so will significantly increase success rate.
Ultrasound-assisted peripheral line placement
Peripheral IV placement
Central venous catheterization
Intraosseous access
External jugular vein cannulation
IV fluid resuscitation
IVC ultrasound
Tourniquet