Ultrasound Guided Peripheral IV Insertion

Study objective The purpose of this research study is to compare 2 established peripheral IV
insertion techniques (traditional vs ultrasound guided) in order to develop an algorithmic
approach to peripheral IV insertion. Patient characteristics, medical history and
co-morbidities, in addition to a pre-insertion physical exam vein assessment, will allow for
the introduction of a vein classification system and a difficult IV insertion algorithm.
Selecting the optimal modality for initial IV insertion will decrease the total number of
attempts, facilitate appropriate gauge and location of IV insertion, avoid central line
placement, decrease IV insertion pain scores and improve patient satisfaction. Currently,
ultrasound guided peripheral IV insertion is performed by the IV team at Cedars-Sinai Medical
Center or a trained anesthesia provider as a rescue technique after multiple failed attempts
by traditional technique. Secondary to the constraints of both trained providers and
equipment resources, the cohort of difficult IV insertion patients are subjected to multiple
traditional IV insertion attempts prior to escalation to ultrasound guidance and
occasionally, unnecessary central line placements indicated by only poor intravenous access.

Primary end point: Grade 2A vein classification cohort 2nd IV insertion attempt success rate
comparison of traditional vs ultrasound guided technique, IV insertion pain scores, Patient
satisfaction Secondary end points: Grade 2B and grade 3 vein classification ultrasound guided
IV insertion success rate. Grade 1 and 2a vein classification 1st attempt IV insertion
success rate. Grade 1 visualization 2nd attempt IV insertion success rate comparison of
traditional vs ultrasound guided technique. Difficult IV insertion risk factors and
associations, IV gauge and location, central line placement because of inadequate peripheral
IV access

Inclusion Criteria:

- All patients requiring pre-operative IV

Exclusion Criteria:

- Emergency Surgery, patient refusal, non-english speaking (USGPIV modality available to
them but time restrictive to consent for study), pediatrics