How to: Ultrasound-Guided Peripheral IV Insertion
Point-of-care guide for ultrasound-guided peripheral intravenous catheter placement.
Setup & Positioning
- Patient supine or semi-upright
- Operator positioned on same side as intended IV site
- Linear ultrasound probe used (vascular/PIV setting)
- Machine positioned for direct line-of-sight ergonomics
Probe Placement & Vessel Selection
- Place probe on mid-to distal forearm
- Orient marker toward clinician's left shoulder (transverse approach)
- Identify suitable vein: compressible, hypoechoic circular structure
- Avoid areas near flexion/movement
- Minimize probe pressure to avoid collapsing vein
- Adjust depth and gain for optimal image
- Center target vessel in image
Needle Insertion (Out-of-Plane Technique)
- Insert needle just inferior to probe, near center line
- Needle appears as bright dot on ultrasound
- Advance slowly while tracking tip intermittently
- Adjust probe/needle alignment as needed to maintain visualization
- Repeat incremental advancement until vessel is reached
Vessel Entry
- Observe needle tip indenting then puncturing vein under ultrasound
- Confirm mid-lumen placement
Confirmation (Optional Longitudinal View)
- Rotate probe 90° for in-plane longitudinal view
- Verify needle tip within vessel lumen
Catheter Advancement
- Advance catheter off stylet into vessel
- Complete IV placement
Alternate Technique
- Entire procedure can be performed using in-plane approach depending on operator preference