Difficult IV: US-Guided Brachial Vein Cannulation - NYSORA | NYSORA

Difficult IV: US-Guided Brachial Vein Cannulation

June 23, 2022

While ultrasound may not be the best tool for cannulating superficial veins, it is indispensable for larger, deeper veins. This video describes an out-of-plane technique of inserting a 16 gauge catheter into a brachial vein in a patient with difficult IV access.

A few important pointers are:

  1. With ultrasound-guided one must use longer catheters to assure that the catheter is sufficiently deeply placed inside the lumen of the vein to prevent dislodgement.
  2. Sterile technique, sterile gloves, and full-size sterile probe cover are recommended.
  3. Use 2-3 mL of lidocaine for skin and SQ tissues to decrease patient discomfort and facilitate the procedure.
  4. Either in-plane or out-of-plane techniques are acceptable. Often, the in-plane is used to confirm the catheter position inside the vein.
  5. When using the out-of-the-plane technique, a creep-up technique is used. With this technique, the ultrasound probe is simultaneously moved as the needle-catheter is advanced to continue to image the advancing needle tip.

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And how do you perform ultrasound-guided IV cannulation? Do you prefer in-plane or out-of-plane techniques? Is Tegaderm – which is used in the video adequate for probe protection during IV cannulation? Should the operator use sterile gloves? We invite you to share your tips for success in the comments in the YouTube comments section!

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