Registered Nurses' Association of Ontario

Considerations for Ultrasound-Guided Technique for the Insertion of PVADs for Persons with Difficult Intravenous Access

  • Appropriate scope of practice and level of training or expertise needs to be considered when applying this recommendation and determining the most appropriate health provider to insert the PVAD.
  • Health providers caring for persons in the community or home-care settings may need to refer persons with DiVA to an acute care setting to utilize ultrasound technology (if traditional methods of PVAD insertion are unsuccessful).
  • A validated scale can be used to determine DiVA. DiVA status should be assessed by an expert in PVAD insertion or a health provider who is appropriately trained to use the validated DiVA scale.
  • Referral to VAS or VASTs may be needed to support the insertion of VADs in DiVA patients using ultrasound-guided technique (in organizations where available).
  • When using ultrasound-guided technique for the insertion of PVAD, it is important that health providers ensure correct positioning of the VAD prior to initiating treatment (i.e., it should be evident on ultrasound that the catheter is positioned properly in the vein). A PVAD insertion attempt is also deemed to be successful if there is evidence of blood flashback in the catheter upon insertion, and if the device flushes easily with no signs of infiltration, swelling or leakage upon flushing.

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Clinical Management
Assessment and Device Selection for Vascular Access
Point of Care Resources