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.
"There's no use trying," she said: "one can't believe impossible things." "I daresay you haven't had much practice," said the Queen. "When I was your age, I always did it for half-an-hour a day. Why sometimes I've believed as many as six impossible things before breakfast."
-- "Through the Looking-Glass" by Lewis Carroll
A common mistake that people make when trying to design something completely foolproof is to underestimate the ingenuity of complete fools.