Peripheral IVs and Extended Dwell PIVs
Peripheral IVs and Extended Dwell PIVs, which are ultrasound guided, are the most common standard lines used for establishing vascular access. These are not central lines and this page describes IV Access, IV Mobile Services, IV Sites, IV Extravasations, and clinically appropriate uses for both of these lines.
| IV Access Services
| IV Access Company
IV Access Sites
| IV Catheter Types
IV Access Sites can vary greatly based on both the skill of the inserter and the patient’s availability of accessible veins. Ideally, IV access can be established in the forearm, as this avoids areas of flexion and irritation to the patient. There are many different sizes and configurations of the IV device itself, but generally, the IV Catheter is a short, small, plastic tube that is placed into the vein over a needle (with the removal of the needle after the tube is in place) at the chosen IV Access Site. In certain patient conditions, varying areas should be avoided for IV Access, patients may need preservation of those sites for future medical needs, or a PIV may harm the patient in a restricted area based on previous surgeries. Essentially, whenever performing vascular access, and regardless of the IV Catheter Types, a careful assessment should be performed to provide the patient with the ideal access to meet their medical needs. Finally, any compromise of skin integrity, including puncture of the skin, is a potential source of infection so all skin preparation should be meticulously performed to prevent unwanted complications.
Radiopharmaceutical Extravasations describe specific situations in nuclear medicine caused by IVs not being properly placed in the veins at the IV Access Sites causing radioactive fluid to go into the skin instead of the vein. This is a great risk and concern in the area of nuclear medicine as the “fluid” is a radiopharmaceutical or radioactive isotope. An incorrect injection that results in fluid leakage into the arm tissue can cause significant adverse consequences including poor imaging, subpar patient treatment plans and care, and patient harm. Unlike other extravasations of therapies that can cause immediate tissue damage, the extravasation of radiopharmaceuticals often has a delayed effect on tissue damage of the patient. These delayed tissue damages have been associated with skin malignancies (cancer) so are especially concerning. Vascular Wellness is a strong supporter of improving IV Access specifically in the area of nuclear medicine through additional training and education and is a corporate sponsor of Patients For Safer Nuclear Medicine.
To learn more about Radiopharmaceutical Extravasations, please visit: Why does Nuclear Medicine greatly depend on proper Vascular Access? and Radiopharmaceutical Extravasations: Hazards…Prevention – Webinar Review.
Peripheral IV, as stated above, is the most basic and least intrusive method for obtaining Vascular Access. It must be clinically indicated and appropriate for infusion into the smaller veins of the periphery, which means the following:
- The prescribed therapy is appropriate for peripheral access as it will not have a damaging effect on small veins.
- The patient has peripheral veins large enough to accommodate a PIV
- The patients’ veins can be accessed without repeated needle puncture
- The ordered therapy is short-term, not needing a longer-term device
A Midline vascular access device is generally the next treatment option if a PIV or Extended Dwell PIV is not clinically indicated. See Midlines for more information.
Learn more in this Peripheral IV Patient Case
Patient cases highlight some of the interesting Nurse Clinicians in Action cases that Vascular Wellness clinicians have encountered and participated in treatment.
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We offer timely, innovative, and advanced vascular access services at the bedside, with full administrative support, from skilled employees who care.
VASCULAR ACCESS SPECIALISTS
As Vascular Access Specialists, Vascular Wellness nurse clinicians are Vascular Access Board Certified (VA-BC), insured, skill-verified, and salaried W2 employees. Vascular Wellness requires bi-annual skill verification ensuring adherence to proprietary policies, procedures, competencies, and best practices. We focus on holistic and comprehensive care and do not follow the pay per procedure model plus performance bonuses used by others that may create some adverse incentives for speed at the bedside versus holistic medical care helping to ensure the placement of the right line at the right time, the first time. In fact, Vascular Wellness employs a Director of Research and Development who not only helps us stay up to date on best practices but helps us continue to innovate and improve upon Vascular Access Services.
Vascular Access Specialists practice holistic medical care, meaning talking to the patient, addressing questions and fears, and performing a comprehensive medical review. Prior to delivering any Vascular Access procedure, the Vascular Wellness clinician reviews the patient’s medical record, including history and lab reports, and independently verifies and confirms the doctor’s order. If our clinician has questions or disagrees with the prescribing doctor, the clinician will consult with the doctor. Our Vascular Access Specialists have earned the trust of many doctors, and such doctors will defer to the clinician’s recommendation by ordering a “consult” as compared to a specific line. Patient safety and vein preservation are critical – which is why a holistic, comprehensive evaluation and Advanced Lines are significant. Other companies claiming to be Vascular Access Specialists may not follow this same approach frustrating medical doctors and nurses primarily because those 1099 Contractor PICC nurses do not place Advanced Lines (i.e, no options other than PIVs, Midlines, and PICCs) and get paid on a pay per procedure model.
In states where nurses are permitted, as Vascular Access Specialists, Vascular Wellness clinicians can provide immediate X-Ray Clearance of lines when tip confirmation is not available or appropriate and X-Ray confirmation must be used. This saves money, time, and coordination with a Radiologist or other doctor and enables the lines to be used immediately to avoid delaying treatment. Quicker therapy leads to better outcomes.
As Vascular Access Specialists, Vascular Wellness uses top rated and hospital preferred supplies from Becton Dickinson, formerly Bard (BD). Superior supplies and services help mitigate the potential for poor outcomes such as bad placement, clotting, infections, and other adverse events. Other companies that are not Vascular Access Specialists may opt for inferior supplies and older equipment.
*Image attribution: Ultrasound-Guided Peripheral Intravenous Line Placement: A Narrative Review of Evidence-based Best Practices – Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/Ideal-hand-position-for-ultrasound-guided-peripheral-intravenous-line-placement_fig5_320574943 [accessed 11 Jan, 2023]*Peripheral IV Placement using Ultrasound
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Vascular Wellness provides comprehensive, quality, timely, and innovative vascular access services, including standard and advanced line placement, pediatrics, program management, education, training, and infection control and prevention to all healthcare settings such as Tertiary Hospitals, Community Hospitals, Long-Term Acute Care Hospitals, Hospital at the Home Programs, Skilled Nursing Facilities, Surgical and Outpatient Centers, Hospice, and At-Home care. We support a 98+% Success Rate with 0% Insertion-Related Infection Rate across all lines, with an average response time of 3 hours. We help our clients improve patient outcomes, enable faster therapy, reduce costs, infections, and readmissions, decrease hospital length of stay, and reduce transportation expenses.
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Saturday-Sunday: 8am - 3pm
Holidays: 8am - 1pm