Ultrasound for IVs

[Lecithin5]

One of our small Surgical Centers is looking to purchase an ultrasound exclusively for the occasional difficult IV placement (hey, they have the cash and they wanna buy one). Literally for nothing else- only IVs. So obviously not looking for anything fancy (ie expensive). Any leads on what might be an acceptable ultrasound.

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[patriot6]

butterfly with ipad / iphone setup

One of our small Surgical Centers is looking to purchase an ultrasound exclusively for the occasional difficult IV placement (hey, they have the cash and they wanna buy one). Literally for nothing else- only IVs. So obviously not looking for anything fancy (ie expensive). Any leads on what might be an acceptable ultrasound.

 

[nimbus]

Compared to a small linear probe, I found the butterfly less than ideal for IVs. The device is too large and cumbersome and the footprint is too big.

 

[Lecithin5]

Compared to a small linear probe, I found the butterfly less than ideal for IVs. The device is too large and cumbersome and the footprint is too big.

Thanks. I suspected that the Butterfly would be a popular suggestion, but I have no experience with them. The website demo for PIV insertion looks really good, but I’m not sure if that’s an actual reflection of true quality.

 

[coffeebythelake]

Have they considered an infrared veinfinder instead?

 

[surgndoc]

Butterfly is garbage for IVs. Buy a used US from a radiology department or something.

 

[Guillemot]

Just put in central lines in everyone

 

[nimbus]

Just put in central lines in everyone

Landmark!!

 

[patriot6]

Butterfly is garbage for IVs. Buy a used US from a radiology department or something.

Nah, I use it all the time. It’s fine; more than adequate. It has a larger footprint and heavy, so small learning curve in avoiding too much pressure from the probe… and also staying shallow to allow needle to enter into actual scanning frame. I use it all the time for out of department lines that come up from time to time.

 

[surgndoc]

Nah, I use it all the time. It’s fine; more than adequate. It has a larger footprint and heavy, so small learning curve in avoiding too much pressure from the probe… and also staying shallow to allow needle to enter into actual scanning frame. I use it all the time for out of department lines that come up from time to time.

That’s fair, it’s just not my favorite and we have better equipment in my opinion although I don’t really know the relative costs.

 

[DocVapor]

Nah, I use it all the time. It’s fine; more than adequate. It has a larger footprint and heavy, so small learning curve in avoiding too much pressure from the probe… and also staying shallow to allow needle to enter into actual scanning frame. I use it all the time for out of department lines that come up from time to time.

Exactly. I get called on an almost daily basis for PIV's. I have never had to ask someone to go get a standalone u/s because I've failed with my butterfly probe outside of peds cases.

Is the picture as good as a standalone with a small linear probe? No, of course not. But if you take the time to learn how to use it you can get a line anywhere, including placing midlines in fluffy arms and placing a cordis quickly during a ruptured AAA case (both things I have done).

My suggestion would be that if it's owned by the ASC to spring for the iPad as the small phone screen is limited (can only display in portrait orientation whereas the iPad can display portrait and landscape).

 

[Iso4ane]

GE has the VScan with uses an app like the Butterfly, but is wireless, does not need a yearly subscription, has a smaller footprint, is double ended (linear on one side, curvilinear on the other ) and has adequate imaging quality from the one I seen in the past.

 

[zizzer]

If they're paying and don't care, get a nice SonaSite linear probe. They're excellent. If cost is an issue, the Butterfly probe is perfectly adequate for PIVs. Sure, something that costs $20-30K will be better than something that is $2-3K, but I've used worse ultrasounds than the Butterfly. It's good for what it is and should be all you need. I've used it for arterial lines, PIVs, and even an emergency IV CVC once. It's super convenient that the app automatically turns on when I plug it into my phone. Even when I have the ultrasound on wheels available, I sometimes prefer the speed of access rather than having somebody bring the other probe, power it on, etc.

A surgery center probably should invest in something on wheels though unless they're really strapped for cost.

 

[Lecithin5]

If they're paying and don't care, get a nice SonaSite linear probe. They're excellent. If cost is an issue, the Butterfly probe is perfectly adequate for PIVs. Sure, something that costs $20-30K will be better than something that is $2-3K, but I've used worse ultrasounds than the Butterfly. It's good for what it is and should be all you need. I've used it for arterial lines, PIVs, and even an emergency IV CVC once. It's super convenient that the app automatically turns on when I plug it into my phone. Even when I have the ultrasound on wheels available, I sometimes prefer the speed of access rather than having somebody bring the other probe, power it on, etc.

A surgery center probably should invest in something on wheels though unless they're really strapped for cost.

Thx- they’re not strapped for cash, but they aren’t looking to spend tens of thousands- I imagine less than 5-10k

 

[zizzer]

Yeah, in my opinion, you only need better ones for nerve blocks. For PIVs they're a luxury.

 

[HalO'Thane]

Exactly. I get called on an almost daily basis for PIV's. I have never had to ask someone to go get a standalone u/s because I've failed with my butterfly probe outside of peds cases.

Is the picture as good as a standalone with a small linear probe? No, of course not. But if you take the time to learn how to use it you can get a line anywhere, including placing midlines in fluffy arms and placing a cordis quickly during a ruptured AAA case (both things I have done).

My suggestion would be that if it's owned by the ASC to spring for the iPad as the small phone screen is limited (can only display in portrait orientation whereas the iPad can display portrait and landscape).

That's impressive. What type of screen are you using (iphone vs ipad)? Also, do you use anything to either prop the screen up or hang the screen on a pole? I just find the ergonomics of a hand held device to be a pain for placing lines if you are staring down on the screen. Plus I never know where to set the screen down. This to me makes the standalone probes so much easier.

 

[BobLoblaw78]

I also appreciate the simultaneous in plane and out of plane views with the butterfly.

 

[DocVapor]

That's impressive. What type of screen are you using (iphone vs ipad)? Also, do you use anything to either prop the screen up or hang the screen on a pole? I just find the ergonomics of a hand held device to be a pain for placing lines if you are staring down on the screen. Plus I never know where to set the screen down. This to me makes the standalone probes so much easier.

I use my work-issued iPhone. I bought a case that has a stand which allows it to stand up portrait but because of the plug location on the phone I find I mostly plop it down wherever I can that doesn't cause too much light reflection. I've done it enough at this point that I can be turned around practically backwards and not have any trouble. Once I have the needle tip through skin in my chosen location I only watch the screen and I played enough video games growing up that it helped with the coordination.

I've not had the opportunity to use any of the other handheld ones, but the idea of a wireless probe sounds nice. I would worry about probe weight and image lag though.

 

[zizzer]

A stand would be nice, but I just set it down or have a nurse hold my personal phone while I look at it.

 

[nimbus]

Basically agree with everything said above about the Butterfly. It’s just not my preferred ultrasound. It’s better suited to needling deeper structures (IJ and brachial veins). For very superficial veins and arteries, you need to adjust technique by approaching with the needle at a very shallow angle.

 

[Simba1711]

I find the vein finders to be useless for piv. Do other guys find it helpful ?

 

[Arch Guillotti]

I find the vein finders to be useless for piv. Do other guys find it helpful ?

Almost never helpful.

 

[HalO'Thane]

If you are only looking for PIV placement you might want to look into the Lumify by Philips. Philips sells probes that mimic a standalone probe (e.g. separate linear, curvilinear, and phased array probes). I have found the image quality for this to be far superior to the Butterfly at close to the same price per probe. They have an active youtube channel full of video clips. Here is a scan of the carotid artery that gives you an idea of the image quality:



I also like that you don't have to worry about a subscription service or the images being sent to some cloud the way Butterfly does.

 

[coffeebythelake]

I find the vein finders to be useless for piv. Do other guys find it helpful ?

really? i'm a big fan..

 

[Maz777]

Clarius best. Lumify 2nd. Butterfly is designed to work well within the confines of a trash can. That's where mine currently is. About as useful as a veinfinder POS.

 

[Simba1711]

Using a tourniquet and then wrapping this around the arm usually puffs up the veins pretty well.

https://www.cardinalhealth.com/en/product-solutions/medical/surgical/or-accessories/esmark-bandages.html

 

[vector2]

Sonosite > Lumify > Butterfly

That being said I've used my butterfly at least a hundred times for PIVs and a-lines, and I've never had to stop and go get the sonosite because the butterfly wasn't good enough. However, there is a learning curve given the big footprint of the butterfly and the fact that the image quality/resolution isn't that good.

 

[anesthesiadoc]

Have they considered an infrared veinfinder instead?

So much yes! I use this all the time for patients with obesity, babies, and everything in between.

 

[Drwine]

One of our small Surgical Centers is looking to purchase an ultrasound exclusively for the occasional difficult IV placement (hey, they have the cash and they wanna buy one). Literally for nothing else- only IVs. So obviously not looking for anything fancy (ie expensive). Any leads on what might be an acceptable ultrasound.

No chance of using it for blocks in the future? I would buy a last generation Sonosite.

 

[Lecithin5]

No chance of using it for blocks in the future? I would buy a last generation Sonosite.

Nope- this particular center only does one kind of (non-block) case, in high volume… would only be for the occasional IV

 

[nimbus]

Nope- this particular center only does one kind of (non-block) case, in high volume… would only be for the occasional IV

ASRA guru will invent a block for it.