It depends on how good the pulse is, but in general I love ultrasound. In bigger people if there's a good pulse, it would probably take me longer to grab the ultrasound, get the sterile sleeve and do the line under guidance than just putting it in. In my infants or anyone with a bad pulse (especially in the situation you describe), definitely ultrasound FTW.
To suture, I put an anchor stitch proximal to the line, then pull the thread through the wing holes and tie it again. Then tape or tegaderm it down.
I think ultrasound can be put to great use in the ICU setting, and we could probably use it much more than we do.
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