Introduction

What is Advanced Ultrasound - Ultrasound technology has made it possible to easily and accurately identify veins, arteries and nerve bundles of the upper arm. However, ultrasound can also be used to perform a more advanced assessment of vein characteristics, making it possible to determine vein suitability for catheter placement prior to cannulation attempts. Scanning with ultrasound before attempting to place a peripherally inserted central catheter (PICC) permits the identification of vein anomalies or abnormalities, allowing the clinician to choose the best available insertion site or, if indicated, avoid catheter placement in the upper extremities altogether. Up to this point, ultrasound use for PICC placement at the bedside has focused on vessel identification and visualization to aid needle access, thereby eliminating the need for “blind sticking”. Through a more advanced application of ultrasound technology, it is possible to identify vein characteristics that contribute to catheter related complications such as inability to thread, post insertion phlebitis and thrombosis, all of which can result in catheter removal, loss of access, increased cost, delays in or the need for additional treatment and increased length of stay. Learning to use ultrasound to aid critical thinking for vein selection is the essence of an advanced assessment program. Developing scanning techniques and assessment protocols that take full advantage of the technical and clinical benefits of bedside ultrasound should be a goal of all health care professionals inserting vascular access devices. As we more fully incorporate the use of available technologies into practice, our goal is not just to achieve greater success with access device placement, but to increase patient safety and satisfaction through advanced practice initiatives designed to increase optimal outcomes. Ultrasound can guide us to greater success with PICC placement2, directed by sound judgment and advanced assessment.