Written by: Renata Mantegassi Cáceres
- Is it a new technology?
The first use of US for central venous access dates back to 1984. In the United States, since the beginning of the 1990s, nurses started using the US to insert PICC and the description of the first peripheral puncture guided by US, made in 1999, points 91% success in using this approach (KEYES et al., 1999).
The American Emergency Nurses Association (ENA) recommended as level “A” of evidence the use of ultrasound for difficult intravenous accesses (constitutes a non-invasive procedure, which does not use ionizing radiation and can visualize deeper vessels, difficult to be accessed by blind palpation or even by some procedures that use near-infrared rays (FLATO; PETISCO; SANTOS, 2009; CROWLEY et al., 2011).
2. And why should I consider using the US?
Nursing is a constantly evolving science and professionals must keep themselves updated. In line with technological developments and always based on national and international recommendations and literature, infusional therapy makes a leap in quality and safety when it includes in its list of procedures the use of ultrasound equipment to identify / direct peripheral venous access .
… Use technology to visualize the venous network (for example, near-infrared rays, ultrasound) to increase success in patients with difficult venous access (see Standard 22, Vascular Visualization).
INS, 2016.
… Use visualization methodology for installing catheters in adults and children with difficult venous network and / or after unsuccessful puncture attempts 29-32. (I)
ANVISA, 2017.
… For patients with difficult venous access, US-guided peripheral puncture demonstrated an overall success rate of over 90%, compared to 25-30% using the conventional puncture technique [2–4, 6]. Patient satisfaction levels also increase with the use of US [2].
Blanco Ultrasound J Ultrasound-guided peripheral venous cannulation in critically ill patients: a practical guideline (2019) 11:27 https://doi.org/10.1186/s13089-019-0144-5
3. How does the US impact my care practice? What changes?
Always thinking about improving the quality of care and patient safety, it is possible to associate the use of technology with a series of strategies developed to reduce the risks associated with health care, which are brought to the daily practice of professionals in the form of sets or intervention packages - the famous bundles. These seek, among other objectives, to assist in the standardization of clinical conduct, reducing the variability in the care provided and providing care guidelines to professionals, facilitating decision-making and maintaining the culture of care protocols.
Quality and safety in health care is not known without considering the correct execution of the aseptic technique, which is recognized as an essential component of all infection prevention programs. It is widely practiced by professionals in the hospital environment to keep patients protected and with a minimal risk of contracting any types of infections caused by nosocomial microorganisms.
Associating the incorporation of new technologies to daily practice and the correct execution of the aseptic technique, it is appropriate to know that a specific kit for guided puncture is already available on the national market - a unique product that presents itself as an alternative to assist in the construction of the bundle for management of peripheral venous access.
Summing up:
- US-guided peripheral venipuncture is considered a very viable alternative to the conventional method, especially in patients with compromised venous network, history of multiple unsuccessful punctures, in long-term use of infusion therapy (QT), edema, obese, users of drugs, pediatric and others.
- Like any other technique we have learned, it involves some very relevant aspects that must be considered by the professional who wants to start this “adventure” - always remembering that the challenge is what motivates us:
(these points should only serve to make expectations clear)
- It requires dedication and study, to know the equipment, identify and differentiate structures, now seen from new perspectives
- Demands a challenge: The nurse needs to learn to “take your eyes off the puncture area and return them to the equipment monitor”
- Requires training to acquire skills and intimacy with the equipment, in addition to hand-eye coordination
- Requires availability of time and persistence: At first the procedure may seem complex and time-consuming, hindering more than helping with the execution of the puncture
- It takes patience - all new knowledge goes through a learning curve before it becomes automatic
