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New tool avoids sticking patients 10-15 times
It happens in every ED: Patients with difficult line access are stuck multiple times — some as many as 10-15 times — in an attempt to access an intravenous (IV) line. "Eventually, someone gets a small IV that works, or a central line is placed," says Michael Blaivas, MD, RDMS, director of emergency ultrasound at Medical College of Georgia in Augusta.
Imagine what that scenario does to your patient satisfaction scores.
In some cases, patients may have almost no peripheral veins left, notes Blaivas. "The nurses or physicians cannot palpate any, or all are clotted off," he explains. The Medical College of Georgia’s ED recently invested in the ilook 25, a tool for ultrasound-guided line placement manufactured by Bothell, WA-based SonoSite, says Blaivas. (See contact information for two manufacturers of this technology at the end of this article.) "It allows you to look for different locations, look deeper, or simply find veins that are there all the time but cannot be felt seen or easily hit with a blind stick," he explains.
The tool is easy to operate and provides good image resolution for better accuracy in detecting blood vessels for any patient who is a difficult access, either peripheral or central, he says. Both nurses and physicians use ultrasound for line placement, and nurses often bring out the tool without involving a physician, says Blaivas. "This saves time in itself as the nurse does not need to hunt down another person," he says. "Our nurses stop after two or three attempts as they quickly realize someone is an access problem, then the ilook comes out, a vein is visually located, and an IV is placed."
There is a risk of central lines leading to infection and deep vein thrombosis, both of which can lead to death, notes Blaivas. "In the case of patients getting a central line just for access or convenience, one needs to think twice," he says. "That is where the ilook 25 can also make a big difference."
Before you invest in this technology, it is essential to consider the following items:
The ilook 25 costs approximately $12,000 to $15,000, says Blaivas. However, staff resources and delays are significantly reduced, he adds. A patient who used to be stuck by three or four nurses and waited an hour or more to get labs can be accessed much more quickly, he says. "It frees up the nurse to do other things," Blaivas says. "Also, fewer IVs are used, and antibiotics or other vital medications can be given right away."
• Patient and staff satisfaction.
Patient satisfaction is likely to improve, because patients who previously were stuck multiple times now may be accessed after only one or two attempts, says Blaivas. "Staff satisfaction also increases as nurses and physicians placing these lines feel a higher mastery of this technology, more self-reliance, and improved care delivery to their patients," he adds.
A short training program includes an introductory lecture followed by practice on an inanimate arm with a vein that appears similar to human tissue on ultrasound, says Blaivas. "Then we encourage the students to take their first try using the machine on a live patient that is not a horribly difficult stick, so that the time pressure is not as great," he says. "Thus, their first experience is less anxious on a real patient."
For more information about the use of the ilook 25 in the ED, contact:
• Michael Blaivas, MD, RDMS, Director of Emergency Ultrasound, Medical College of Georgia, 1120 15th St., AF-2039, Augusta, GA 30912-4007. Telephone: (706) 721-2613. E-mail: firstname.lastname@example.org.
• The iLook 25 personal imaging tool is an ultrasound designed for vascular access, with all-digital broadband imaging for clear visualization of veins and arteries. For more information, contact SonoSite, 21919 30th Drive S.E., Bothell, WA 98021-3904. Telephone: (888) 482-9449 or (425) 951-1200. Fax: (425) 951-1201. E-mail: email@example.com. Web: www.sonosite.com. Under "Vascular Access," scroll down to "Products/Solutions" and click on "iLook25."
• Site-Rite Ultrasound System is a series of ultrasound scanners designed for vascular access and equipped with disposable needle guides. They range in price from $10,040 to $17,275. For more information, contact Dymax Corp., 271 Kappa Drive, Pittsburgh, PA 15238. Telephone: (800) 296-4146 or (412) 963-6884. Fax: (412) 963-6179. Web: www.site-rite.com.