The "Peripheral Access Utilizing Sonographic Evaluation" Study (PAUSE)

Inclusion Criteria:

• The patient is >= 21 years of age
• Adult critically ill patients in CCU and MICU requiring short peripheral intravenous access
• The patient has been identified as difficult intravenous access (DIVA), defined as at least two failed blind sticks in the antecubital fossa or more distal upper arm veins
• The patient does not otherwise require a CVC

Exclusion Criteria:

• The patient has a PICC line on the same side as IV placement and has the following:

  • Has a condition poses risk for DIC, inadequate flow, or infection.
  • Has been identified as a site for "Save the Vein" protocol implementation, unless permission is otherwise obtained by the patient's physician.
  • Has a hemodialysis fistula in place on that upper arm side.

• The patient is expected to require therapeutic agent or procedure that necessitates central venous access such as:

  • central venous monitoring
  • Total Parenteral Nutrition
  • Antibiotic requiring central venous access
  • Chemotherapy
  • Vesicants
  • Medications pH less than 5 or more than 9
  • Medications of glucose concentrations above 10%
  • Solution with protein concentrations above 5% (Vascular Access Management, n.d.)
• The patient already has a central venous catheter access, for reasons other than DIVA, through which therapy can be infused
• The patient has renal disease and a "Save The Vein" order is anticipated or pending (serum creatinine >2mg/dL and GFR <20) for one of the patient's arms, unless permission is otherwise obtained by the patient's physician
• The patient has a bleeding disorder, unless permission is otherwise obtained by the patient's physician
• The clinician believes the patient is not a good fit for the study or that the procedure is not appropriate for patient at the given moment