Best affordable US probe for peripheral IV placement?

[grenz]

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Hi all,

I work in a radiation oncology clinic that occasionally infuses radio pharmaceuticals. We had a difficult stick the other day, and it’s motivated me to consider getting trained to place US guided peripheral IVs. We will not have a high utilization of the US, so a balance of cost and image quality is desirable. Could you make any recommendations on a probe/machine that would fit these requirements?

 

[CopaceticOne]

Hi all,

I work in a radiation oncology clinic that occasionally infuses radio pharmaceuticals. We had a difficult stick the other day, and it’s motivated me to consider getting trained to place US guided peripheral IVs. We will not have a high utilization of the US, so a balance of cost and image quality is desirable. Could you make any recommendations on a probe/machine that would fit these requirements?

There is no “training” needed if you’ve ever done any other procedure under U/S guidance - IJ CVL, paracentesis, thoracentesis, fluid aspiration, etc.

Pick a higher frequency linear transducer for crisper shallow images. The majority of cost of ultrasound equipment is in the transducer probes.

 

[EctopicFetus]

Hi all,

I work in a radiation oncology clinic that occasionally infuses radio pharmaceuticals. We had a difficult stick the other day, and it’s motivated me to consider getting trained to place US guided peripheral IVs. We will not have a high utilization of the US, so a balance of cost and image quality is desirable. Could you make any recommendations on a probe/machine that would fit these requirements?

Buy a used one.. or get a butterfly or something similar. US for IV placement seems to be a very cheap need.

 

[Powdermonkey]

Buy a used one.. or get a butterfly or something similar. US for IV placement seems to be a very cheap need.

I haven't been super impressed with the butterfly when I've used it recently at conferences. Its a little more grainy than I like. Plus it's a subscription based service. I think the Butterfly is a chip based US wave vs crystals. I'd rather spend a bit more and get a GE or real probe that I can use with an iPad or larger phone. The handhelds are typically $4-5k, some have monthly or annual subscription as well.

As far as the need for one, I think it that once you get proficient with it, you'll miss once out of 75-100 times vs 1 out of say 20-25 times without. If you could come up with another use for them, I think it could be well worth it, but JUST for IVs and patient comfort? I think it's a little harder to make a good case for it for that alone.

 

[grenz]

I haven't been super impressed with the butterfly when I've used it recently at conferences. Its a little more grainy than I like. Plus it's a subscription based service. I think the Butterfly is a chip based US wave vs crystals. I'd rather spend a bit more and get a GE or real probe that I can use with an iPad or larger phone. The handhelds are typically $4-5k, some have monthly or annual subscription as well.

As far as the need for one, I think it that once you get proficient with it, you'll miss once out of 75-100 times vs 1 out of say 20-25 times without. If you could come up with another use for them, I think it could be well worth it, but JUST for IVs and patient comfort? I think it's a little harder to make a good case for it for that alone.

Thanks that’s really helpful. How many cases do you think it takes to get proficient? I occasionally had to try it my intern year and wasn’t successful. It was occasional though.

 

[maxxor]

I haven't been super impressed with the butterfly when I've used it recently at conferences. Its a little more grainy than I like. Plus it's a subscription based service. I think the Butterfly is a chip based US wave vs crystals. I'd rather spend a bit more and get a GE or real probe that I can use with an iPad or larger phone. The handhelds are typically $4-5k, some have monthly or annual subscription as well.

As far as the need for one, I think it that once you get proficient with it, you'll miss once out of 75-100 times vs 1 out of say 20-25 times without. If you could come up with another use for them, I think it could be well worth it, but JUST for IVs and patient comfort? I think it's a little harder to make a good case for it for that alone.

These are 200 millicurie infusions. You want the IV to be pristine.

OP- Do you have an IR colleague you like? They may have a lead in a good portable US that won’t break the bank.

 

[Powdermonkey]

Thanks that’s really helpful. How many cases do you think it takes to get proficient? I occasionally had to try it my intern year and wasn’t successful. It was occasional though.

I think it depends. 20-30, maybe more? Some folks pick it up a lot quicker.

 

[EctopicFetus]

I quickly learned how to do US guided IVs quite some time ago. I no longer am ever willing to do them. If staff are unable to obtain IV access, I do a femoral stick for blood draw or place a CVC. If you do US guided IVs, instantly no one can get an IV ever. If you don’t, magically patients always have an IV.

I bring this up since the question that needs to be asked and addressed before purchasing an US just for IV access is should a physician ever be responsible for this at all? This should be the facility’s responsibility and is in the scope of non-physician staff. If the staff need assistance with obtaining IV access, then they need an US provided by the facility and need to be trained. That’s not a physician’s responsibility (only caveat being if physician ownership in the facility given the question is for a non-ED environment).

Yeah. We trained our nurses and therefore they ask our docs almost never. When our residents do their US rotation we ask the nurses to get them to do it for the reps cause it doesnt exist otherwise. Then again, when you moonlight or perhaps the job you get after residency may require you to place IVs. You could be at a small hospital and the nurses there are old and crotchety and cant get the line. At that point it is the docs responsibility including but not limited to a CVC. When I was younger I moonlit at places with no US. I truly didnt get good at them until after residency. We didnt do them much if at all in residency since use of US in the ED was in its infancy. I mean I placed IJs as an intern with no US cause there wasnt one in the dept at one of the places we rotated.

 

[EctopicFetus]

I think it depends. 20-30, maybe more? Some folks pick it up a lot quicker.

I think the more video games you played as a kid and experience you have with US overall the quicker it will go.

 

[grenz]

I think the more video games you played as a kid and experience you have with US overall the quicker it will go.

In our line of work we use US to guide needles into the prostate, so I understand the concepts. It was always the very small movements and structures that made PIV difficult for me. Also absolutely no US guided PIV training aside from the senior resident showing me didn’t help.

 

[grenz]

I quickly learned how to do US guided IVs quite some time ago. I no longer am ever willing to do them. If staff are unable to obtain IV access, I do a femoral stick for blood draw or place a CVC. If you do US guided IVs, instantly no one can get an IV ever. If you don’t, magically patients always have an IV.

I bring this up since the question that needs to be asked and addressed before purchasing an US just for IV access is should a physician ever be responsible for this at all? This should be the facility’s responsibility and is in the scope of non-physician staff. If the staff need assistance with obtaining IV access, then they need an US provided by the facility and need to be trained. That’s not a physician’s responsibility (only caveat being if physician ownership in the facility given the question is for a non-ED environment).

This is a freestanding physician owned office. I think the goal would be I learn and get good at it, then train my nurse.

 

[grenz]

These are 200 millicurie infusions. You want the IV to be pristine.

OP- Do you have an IR colleague you like? They may have a lead in a good portable US that won’t break the bank.

This is my thought too. We are now screening for difficult sticks, and if someone has exclusively required US guidance I’d almost be inclined to refer them to the hospital for their radiopharmaceutical. In that paradigm, the US would pay for itself (we are physician owned and get the drug payment)

 

[MechEDoc]

Get something with a small footprint linear probe. I'd look at a used unit (sonosite?) over a butterfly IQ. The butterfly IQ is much harder to see small structures, etc. It can be done, but a Edge or M-turbo is still better.

 

[BoardingDoc]

Thanks that’s really helpful. How many cases do you think it takes to get proficient? I occasionally had to try it my intern year and wasn’t successful. It was occasional though.

Able to do it? 10 or so. Able to get them so they stay and don't blow? 30+.

These are 200 millicurie infusions. You want the IV to be pristine.

OP- Do you have an IR colleague you like? They may have a lead in a good portable US that won’t break the bank.

I've found that if you can use a longer IV than the standard catheter, the risk of it blowing goes down dramatically. Long view. Needle into vein. Advance needle all the way until it's hubbed, watching it advance the entire time so you know you're not backwalling it or anything. Deploy catheter/retract needle.

When I've done it this way with a longer length IV, I don't think I've ever had it blow.

 

[grenz]

Do you think this catheter system would help with increasing the success rate? Reminder that this is a new procedure for us and it would probably take a year to get to 30 difficult sticks.

AccuCath Ace™ Intravascular Catheter | BD

Empowering nurses to put patients first.

www.bd.com

 

[WhatJobDoIPick]

I quickly learned how to do US guided IVs quite some time ago. I no longer am ever willing to do them. If staff are unable to obtain IV access, I do a femoral stick for blood draw or place a CVC. If you do US guided IVs, instantly no one can get an IV ever. If you don’t, magically patients always have an IV.

I bring this up since the question that needs to be asked and addressed before purchasing an US just for IV access is should a physician ever be responsible for this at all? This should be the facility’s responsibility and is in the scope of non-physician staff. If the staff need assistance with obtaining IV access, then they need an US provided by the facility and need to be trained. That’s not a physician’s responsibility (only caveat being if physician ownership in the facility given the question is for a non-ED environment).

I'll never understand how this became a doctor task. Actually I do, because EPs are a bunch of p****** and don't stand up for themselves.

 

[CopaceticOne]

Do you think this catheter system would help with increasing the success rate? Reminder that this is a new procedure for us and it would probably take a year to get to 30 difficult sticks.

AccuCath Ace™ Intravascular Catheter | BD

Empowering nurses to put patients first.

www.bd.com

Never seen this catheter before.

 

[Powdermonkey]

Do you think this catheter system would help with increasing the success rate? Reminder that this is a new procedure for us and it would probably take a year to get to 30 difficult sticks.

AccuCath Ace™ Intravascular Catheter | BD

Empowering nurses to put patients first.

www.bd.com

Use it for the easy ones to practice and get the hand/eye coordination down. Aim for one a little deeper. The superficial ones are tough to hit with US because there isn't enough distance to visualize everything. Just get longer angiocaths in the same brand you have, same gauge. That's what we have on our US carts.

 

[grenz]

Thanks for the tips everyone. The consensus here and online seems to be the GE Vscan Air is a good handheld choice. Let’s say I wanted to future-proof and have a portable machine in which you purchase separate probes. For instance, in some rad onc clinics physicians use trans-rectal ultrasound to place gold seeds in the prostate. What would be a good portable machine that has the ability to expand to other procedural needle uses? In my review it seems the Sonosite M-turbo is well regarded?

Keep in mind I would have absolutely no diagnostic uses for it

 

[MechEDoc]

M-turbo is a good basic unit.

You can practice coordination with a straw (the vein) run through tofu and keep the tofu just covered in water / tofu juice. There are lots of ways to go about (long vs short axis), etc. I'm a short axis person, but both approaches have their merits. If you can find someone good to help walk you through a few practice attempts, you'll be fine. I use long 18 g angio caths without issue.

 

[RustedFox]

We have the Vscan Air at our FSEDs. It's great; but the software app it runs on is meh.

Also; down with subscription models. We bought the damn thing; we didnt "rent" it.

Eff outta here with that nonsense.

 

[DrDrummer]

Thanks for the tips everyone. The consensus here and online seems to be the GE Vscan Air is a good handheld choice. Let’s say I wanted to future-proof and have a portable machine in which you purchase separate probes. For instance, in some rad onc clinics physicians use trans-rectal ultrasound to place gold seeds in the prostate. What would be a good portable machine that has the ability to expand to other procedural needle uses? In my review it seems the Sonosite M-turbo is well regarded?

Keep in mind I would have absolutely no diagnostic uses for it

For IVs the M-Turbo would be great. If you can find a used older one that is still within its serviceable lifespan and has the linear probe you need, that or an older Sonosite would be good. But given how expensive they are, if all I was using it for was IV placement I’d be tempted to try one of the Chinese made no brand linear US probes that connect to a tablet. Wont be as good but possibly good enough for $8000 less.

Report back on what you find, I’m interested in this question too.

 

[Lexdiamondz]

I'll never understand how this became a doctor task. Actually I do, because EPs are a bunch of p****** and don't stand up for themselves.

I actually disagree with this. While IV access should not be a primarily physician task, it's embarassing the number of my colleagues who cannot reliably obtain IV access, peripheral or central. I don't love being asked to do USGIV all the time but outsourcing tasks is exactly how scope creep starts.

 

[TooMuchResearch]

I'll never understand how this became a doctor task. Actually I do, because EPs are a bunch of p****** and don't stand up for themselves.

Some of my colleagues will jump in and offer to place US IV when the nurses fail after 1-2 attempts without ultrasound. Somehow when I don't offer, as I never do, they always figure out how to get the access.