Intravenous Cannulation with Ultrasound Guidance

Indications

• Previously confirmed case of difficult IV cannulation
• Failed IV cannulation
• Anticipated difficult IV access (e.g. vein neither visible nor palpable, high adiposity)

Equipment

• IV cannula and associated equipment for cannulation
• Use the linear ultrasound probe 25mm (small one)
• US gel: both non-sterile and sterile
• Ultrasound probe sterile sleeve
• Clean gloves or sterile gloves (preferred)

Positioning and technique

• Wash hands
• Prepare everything as you would for IV cannulation and blood collection
• Put on gloves +/- gown
• Clean large area of skin over the vein with an alcohol wipe or chlorhexidine solution
• Scan and locate a suitable vein (use non-sterile US gel)
• Cubital fossa area or volar aspect of mid forearm are good locations to start with. Otherwise, have a look at the saphenous vein.
• Scan the cross-section of the vein, then turn the probe 90⁰ slowly to scan it longitudinally to see the alignment of the vein

Use either of the two methods below:

• LAMP  = Locate, Align, Mark, Puncture – use US to mark and then cannulate
• LAP = Locate, Align, Puncture – visualise with US in real time

LAMP Approach:

• Scan the vein as above (using non-sterile US gel)
• Mark the vein location using a pen (or tip of a pen cap to make an indentation), on both sides of the probe after aligning the centre of the probe on the vein (cross section view)
• Wipe the gel off with gauze
• Clean the skin again with alcohol wipe or chlorhexidine
• Cannulate the vein as usual using the two marks on the skin

LAP Approach: 

• Cover the US probe with the sterile sleeve
• Apply sterile gel inside the probe sleeve and some on the skin
• Use either the cross-sectional view or the longitudinal view in real time
• Align the centre of the probe with the vein
• Pierce the skin close (2-5mm) to the centre of the probe
• Look for the needle tip entering the vein
• You can see the depression and movement of tissue around it
• If using the cross-sectional view, you will need to slide the probe to follow the tip of the cannula needle

Aftercare

• Clean the ultrasound probe according to the ED guideline: Ultrasound Probe Cleaning (Sonosite).