Ultrasound Guidance Insufficient for DIVA Patient – Nurse Clinicians in Action – 45

Ultrasound Guidance Insufficient for DIVA Patient describes a case where Emergency Department nurses and physicians tried multiple times using ultrasound guidance to achieve vascular access in a sick patient but were unsuccessful primarily due to the patient’s contracted veins.

Ultrasound Guidance Insufficient for DIVA Patient

– Clinical Case

This case took place in the Emergency Department of a Hospital where a patient was being treated with a suspected case of sepsis and needed vascular access for lab work and IV therapies. 

Emergency Department nurses and physicians tried numerous times to place a peripheral IV in this DIVA (Difficult IV Access) patient using ultrasound guidance, but unfortunately, it was insufficient, and they were unsuccessful.  The patient was extremely contracted bilaterally, making the veins very difficult to cannulate.  Vessel contraction, or vasoconstriction, is when the space inside the veins is smaller or constricted.  This particular patient was bilaterally contracted, meaning both arms were affected.

The narrowing of the blood vessels, or vasoconstriction, can be caused by a number of factors.  Medications such as decongestants or anti-inflammatory drugs can affect vessels, as well as stress, smoking, cold temperatures, and certain medical conditions, including sepsis and Raynaud’s disease.   

Ultrasound Guidance Insufficient for DIVA Patient

– Diagnosis and Treatment

With the patient’s condition worsening, the care team knew they needed to get vascular access quickly.  They were relieved to notice a couple Vascular Wellness vascular access clinicians who were taking care of another patient nearby.  The care team quickly asked if the Vascular Wellness clinicians could come over as soon as they were done and assist with this sepsis patient. 

Vascular Wellness’ unmatched skillset and experience means they are often called to achieve access when others are unsuccessful, and fortunately for this client and patient, they were already onsite.  A short while later, the nurse clinicians arrived and expertly assessed the DIVA patient’s vasculature using ultrasound guidance to determine the best approach.  They determined that a Midline in the upper left arm would be the best option for the patient, and quickly and successfully completed the vascular access procedure on the first attempt.  With the Midline in place, the care team was able to begin treatment without further delay.

Vascular Access Specialists 

– Key Points

Utilizing ultrasound guidance for vein visualization is the most effective way to achieve vascular access in patients; however, using an ultrasound does not guarantee success.  Not only does the clinician using the technology need to be highly trained and proficient in its use, but vascular access nursing is a skill that requires regular practice and ongoing skill verification, as is ingrained in the Vascular Wellness culture, and a nurse or clinician who has not worked with a preceptor and is not placing lines regularly on a daily basis can lose proficiency over time.  Furthermore, as Vascular Wellness is a company focused on vascular access nursing, we follow and maintain best practices, participate and lead vascular access nursing organizations, and enable peer support so our nurse specialists have a large support system of Vascular Access Specialists if needed.    

Additionally, it is equally important that the vascular access clinician be highly trained in understanding how other factors such as how the patient’s medical condition and history affects their vasculature, and this too, is an important part of how Vascular Wellness performs and provides vascular access at the bedside. 

In this patient case, as in many others, there were several factors that made this patient a difficult stick even with ultrasound guidance.  Partnering with vascular access specialists and experts who are deeply skilled, particularly in complex cases and patients like this one with difficult IV access, is critically important in ensuring patients receive timely and clinically appropriate treatment without unnecessary and painful sticks and wasted time and supplies.  A Vascular Wellness Vascular Access Nurse is truly a Vascular Access Expert with much more training and experience than, and with all due respect to, a general medical provider with an ultrasound. 

Nurse Clinicians in Action is a spotlight series highlighting some of the interesting cases that Vascular Wellness clinicians have encountered and participated in treatment. These cases involve challenging situations or intriguing clinical presentations and may involve more than one Vascular Wellness clinician, as our clinicians have the ability to consult each other while in the field, as well as an on-call Clinical Administrator via a HIPAA (Health Insurance Portability and Accountability) compliant communication app. In addition, our extensive training program and diverse client base, including Level 1 Trauma Centers, Short Term Acute Care Hospitals, Long Term Acute Care Hospitals, and Skilled Nursing Facilities, provide our clinicians with a wide array of clinical experience and why we believe our clinicians, as a group, are the most experienced and best trained and supported vascular access clinicians.

If you require Vascular Access or want to learn more, speak to the team at Vascular Wellness today.
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Vascular Wellness provides:
(1) Comprehensive vascular access services to North Carolina, Oklahoma, South Carolina, and Virginia; and
(2) Customized vascular access services to Arkansas, Delaware, Georgia, Mississippi, Pennsylvania, Tennessee, and West Virginia; and
(3) Support vascular access services to Ohio and Kentucky.