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Use of Ultrasound Guidance for Peripheral Intravenous Placement in Difficult-to-Access Patients: Advancing Practice With Evidence

Maiocco, Gina PhD, RN, CCNS; Coole, Chris RN

doi: 10.1097/NCQ.0b013e31822b4537

Placement of peripheral intravenous (PIV) lines in difficult-to-access patients can be daunting. Multiple unsuccessful peripheral sticks, numerous PIV restarts, and potentially excess use of peripherally inserted central catheters can result. The goals of this project were to decrease the number of peripherally inserted central catheter referrals and lower the number of PIV restarts by having clinical nurses employ ultrasound guidance when initiating deep PIVs. After 10 months of nurses using the ultrasound as needed to insert a PIV line, the number of total peripherally inserted central catheter referrals decreased by 20%.

Louis A. Johnson VA Medical Center, Clarksburg (Dr Maiocco and Mr Coole), and School of Nursing, West Virginia University, Morgantown (Dr Maiocco), West Virginia.

Correspondence: Gina Maiocco, PhD, RN, CCNS, Louis A. Johnson VA Medical Center, 1 Medical Center Drive, Clarksburg, WV 26301 (

This study was funded by American Association of Critical Care Nurses, Evidence-Based Clinical Practice Grant, December 2009.

The authors declare no conflict of interest.

This material is the result of work supported with resources and the use of facilities at the Louis A. Johnson VA Medical Center in Clarksburg, WV. The contents of this article do not represent the views of the Department of Veterans Affairs or the US Government.

Accepted for publication: June 26, 2011.

Published online before print: August 5, 2011.

© 2012 Lippincott Williams & Wilkins, Inc.