Ultrasound-Guided Peripheral Intravenous Access by Critical Nurses.

Contribution of Ultrasound for Peripheral Intravenous Catheter Placement by Intensive Care Nurses

Peripheral intravenous access is a major intervention in patients admitted to an intensive care unit. Systematically performed by nurses, it is also an essential intervention when the central venous access has to be removed. However, in the intensive care unit, patient centered-characteristics such as previous history of intravenous drug abuse, obesity, history of multiple vascular punctures or fluid overload most often affect the success rate of this procedure. For these patients, failure consequences are numerous: 1) delayed discharge from the intensive care unit, 2) increased pain and dissatisfaction, 3) increased incidence of catheter-related bloodstream infections. The use of ultrasound has gained increasing popularity particularly for obtaining central venous access. We hypothesize that, among trained nurses, ultrasound-guided peripheral venous access could represent an attractive alternative compared to the traditional anatomical method in order to increase the success rate.

Inclusion Criteria:

• patient admitted in ICU
• patient not able to express his opposition
• central venous access that need to be removed
• need for a peripheral venous access
• no clinical instability
• no visible superficial vein due to: BMI> 30, fluid overload, previous history of IV drug abuse, previous history of chemotherapy ,

Exclusion Criteria:

• patient < 18 yo
• pregnancy
• patient under protective supervision
• need for a central venous access