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

| IV Access Services

IV Access and IV Access Services are provided by nurses, PICC Nurses, PICC Services companies, and Vascular Access Services companies. IV Access typically describes IVs, also known as Peripheral IVs and PIVs, including both basic and extended dwell PIVs. IV Access Services is not typically used to describe additional vascular access services of Midlines and PICCs, as those are usually described by the term PICC Services. Furthermore, PICC Services typically do not include advanced lines such as Small Bore Internal Jugular Lines, Femoral Lines, and Axillary Lines as well as Large Bore Lines including Vas Caths for Dialysis and Quad Lumen Lines, as such is usually referred to as Vascular Access Services. Regardless, IV Access Services are critical to patient care as virtually all care starts with access whether IV Access, a Midline, or a Central Line.
Peripheral IV

Peripheral IV

IV Mobile

| IV Access Company

IV Mobile may include a range of mobile nursing companies that provide on-call, on-demand, and on-site IV Access Services. Each may sometimes be called an IV Access Company. IV Mobile companies may provide the IV Access and may provide additional services and assist in the infusion of medication or fluids. Generally, if the IV Nurse is a PICC Nurse, meaning able to insert or place Midlines and PICCs, then there is a greater likelihood that such PICC Nurse will leave after IV Access is obtained leaving the patient in the care of the infusion nurse. IV Mobile companies vary; some may consist of 1099 contractors that do not serve hospitals and others may consist of highly trained, certified employees that are hospital credentialed and serve patients wherever they are located. Not all IV Mobile companies are the same and at Vascular Wellness, we pride ourselves in our training, education, skill-verification, credentialing and our ability to place standard and advanced lines and perform at the highest levels of Vascular Access.

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

 

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.

nuclear medicine

Nuclear Medicine

Peripheral IV

| PIV

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

Midline

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.

Midline Catheter

Midline Catheter

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Vascular Wellnesssm provides clinical vascular access nursing services at the bedside across the Southeast to a diverse client base including Tertiary Hospitals, Community Hospitals, Long Term Acute Care Hospitals, Skilled Nursing Facilities, Surgical and Outpatient Centers,  Hospice, and At-Home care.

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