Right Assessment and Vein Selection

Patient assessment and selection of the most appropriate vessel and insertion location are the first stage of the vascular access cycle within quadrant 1 of vessel health and preservation (VHP). This stage begins at the time of admission and continues as the diagnosis is established and treatment initiated. Many patients receive their first intravenous device during the assessment phase in the emergency department. A peripheral intravenous catheter (PIVC) is most often inserted at this time. The location and method of insertion may not be optimal or may be difficult, depending on patient and clinician characteristics. Once the patient has been stabilized, consideration may be given to the most appropriate vascular access device (VAD) that will provide the most appropriate administration method for the prescribed therapies. These may vary from PIVCs to midlines, peripherally inserted central catheters (PICCs), centrally inserted central catheters (CICCs), and even temporary acute hemodialysis catheters (AHDs). Accurate assessment of the patient’s history, underlying comorbidities, contraindications, available venous pathways, patient diagnosis, and duration of therapy are factors that determine the level of risk, the appropriate device, and the choice of the most qualified inserter. Clinicians with appropriate ultrasound knowledge and training can now apply these learned skills to optimize the assessment and selection of the right location and vessel for all intravascular device insertions.