Paediatric Acute care Guidelines PMH Emergency Department

Pre-Procedure

  • Ultrasound (US) is a very useful tool for difficult intravenous (IV) cannulation

Indications

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

Preparation

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)

Procedure

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

Post-Procedure

Aftercare

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