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Overcoming IV Insertion Obstacles

Laboratory Profiles

Wondering how to develop a contrast program in your lab? Scroll down to take a look at these success stories!

Henry Ford Hospital
2799 W. Grand Blvd.
Detroit, MI 48202

Contact: Echolab Nurse Manager: Gwen Taylor (gtaylor1@hfhs.org)

Henry Ford Hospital Echolab has developed a Policy and Procedure that allows sonographers to place IV lines, as well as inject contrast. The lab manager at Henry Ford, Gwen Taylor, did extensive research to develop a policy and procedure for USCM. Gwen researched the laws and guidelines for sonographers within her state and facility and learned that in Michigan sonographers scope of practice does include venipuncture, so long as the facility allowed the sonographers to place IV lines and a written Policy and Procedure was implemented. Additionally, Gwen confirmed that her lab was functioning within JACHO guidelines and received approval from her Program Director, Assistant Program Directors, and Division Administrator.

After receiving approval to move forward, Gwen developed a Contrast program within her facility that would provide her sonographers venipuncture and contrast injection training. Gwen developed a Policy and Procedure for her facility, as well as 5 satellite sites, to include a standing order. The Policy essentially allowed sonographers to place IV lines and inject, so long as they passed a competency course (for both venipuncture, as well as contrast injection technique). The standing order essentially listed the certified sonographers as they passed their final tests and were deemed competent. The standing order included a blanket physician order for the use of contrast based on the criteria specified within the policy.

The training program that Gwen developed included two packets of information for the sonographers. One packet was educational material on venipuncture, while the other packet was on contrast injection technique. Gwen also provided nurse training and a plastic arm for the sonographers to practice technique on. Each sonographer had to observe 10 successful IV line placements before demonstrating competency by placing an IV themselves. Additionally, the sonographers had to complete a competency checklist and pass a final exam that Gwen developed.

Volunteer Community Hospital
161 Mount Plia Road
Martin, Tenn. 38237
781-587-4261

Contact: Scottie Gilbert x. 3268

Scottie Gilbert is the lead sonographer at Volunteer Community Hospital and had been trained in IV insertion in the past. This lab did not have nursing staff available for the echolab and decided to develop a policy and procedure in which the respiratory therapists would place IV lines and inject when needed for patients scanned in the echolab. This decision was made, as respiratory therapy dept. was located close to the echolab. The Policy and Procedure was established to state that if a respiratory therapist was not available, Scottie could place IV lines and inject when he needed to. Additionally, their policy and procedure stated that nursing staff in ICU/CCU would inject for portable studies, as it would be quicker for Scottie and the other sonographers to have a nurse in the unit inject, as opposed to waiting for a respiratory therapist to come up to the units.

Park Nicollet-Methodist Hospital
Non-Invasive Lab
6240 Excelsior Blvd.
St. Louis Park, Mn. 56420

Contact: Margaret Wolverton, RDMS (952-993-3439)

This lab is located between a clinical building and an adjoining hospital. It serves both outpatients and inpatients. There are currently 20 sonographers performing 50 studies per day. Most of these studies are performed at the main lab, but some are performed at one or more of 4 outreach sites. Contrast is used for all stress studies and about one fourth of transthoracic studies. We follow the same policy at the outreach sites as we do at the main lab.

All sonographers and nurses are trained to insert intravenous lines. The lab policy manual describes the credentials for IV insertion. New sonographers start with a didactic session covering technique and complications. Sonographers then practice on each other, inserting between 10 to 15 IV’s on their colleagues while under observation by a previously credentialed sonographer or nurse. When thy are deemed proficient, sonographers start IV lines on in-patients in the presence of an experienced person. When sonographers have inserted between 10 to 15 IV’s in-patients under observation,they are considered ready to act independently.

Mayo Clinic
Non-Invasive Cardiology Laboratory
200 First St. SW
Rochester, MN

Contact: Mary Hagen, Sonographer e-mail address: hagen.mary@mayo.edu

In order to facilitate ease of use for sonographer’s that are utilizing contrast the lab developed a system to utilize nurses within their department. Essentially, they developed a call rotation for the nurses. Each day a different nurse is assigned to carry a pager for IV insertion and contrast administration. This system promotes ease of use for the sonographers, as this routine facilitates a timely response from the nursing team.

Imaging Tips

Imaging With Contrast Tips & Tricks

GENERAL IMAGING TIPS:

  • Image in Harmonics
  • Decrease the Mechnical Index to 0.1-0.6.
  • Increase Receiver Gains as needed (TGC’s and 2D Gain)
  • Change Dynamic Range and Compression as needed.
  • Place focal zone at the level of the MV.

SCANNING TIPS:

  • Always inject contrast from apical images.
  • Hold probe steady during attenuation.

TROUBLESHOOTING TIPS:

  • The apex is not filling, decrease MI or inject more contrast and inject faster.
  • The contrast is dim, increase receiver gains.
  • There is too much attenuation, inject slower.
  • There is not enough delineation between tissue and blood pool, decrease overall gain.

Overcoming IV Insertion Obstacles

Overcoming Obstacles – Take a look at these innovative ideas!

Southeast Region
Large Medical School
They took internal steps to find the solution. A nurse trained the entire sonographer staff by instructing both didactic and supervised sticks. The institution has now developed a protocol for contrast. They now do their own IV insertion and many of them push the drug.
The other recommendations we have basically are due to a lead sonographer’s initiative to find training and begin the process, never allowing the insertion to be an obstacle in the first place. Others built into their process using other departments and it became a non-issue. Those institutions, for your information, include large university medical centers.

Northeast Region
Large Hospital
Is utilizing nursing staff from CCU to start IV’s and administer the contrast agent in the echo lab and in CCU. We provided a the contrast agent inservice and follow-up for the nursing staff.

Central Region
Large Hospital
The sales representative (Greg) knew that the lack of nursing support would be a key issue in the adoption of the contrast agent into the echo lab. Greg set-up an IV insertion and injecting course for the sonographers to meet the need.
Large free standing imaging Cardiology practice
The lab director hired a home nursing group to come in and train the sonographers in IV insertion. This greatly increased their output.

Western Region
Large Hosptial
This lab utilizes the Nuclear Medicine Techs to administer Definity.

Private Practice
There was no nursing support in the private Cardiology practice, so the lab director identified a Community College course for IV insertion and the cardiologist wrote a letter requesting admission for the Medical Assistants to be certified. The Medical Assistants insert the IV’s and administer Definity.

CMS finalized increase to echo code 93306 and accepted the cardiology community’s proposal that prevents cuts to echoes with contrast