Does the Catheter Length Matter When Placing USG-IVs?

(This post was first published on on April 28, 2017)

Ultrasound-guided IV’s…

This often simple procedure has had probably the biggest impact in my practice and has greatly affected my patient care for the better.  I’ve found myself becoming more and more passionate about this the more I use it, and I want to tell y’all a few of the reasons I do it, and some tips on how to be more successful with them. I’m planning on doing a whole series on ultrasound-guided IV’s, and wanted to start with the topic of IV catheter length.

With regards to the gauge, most studies out there and people I know use catheters between the 18-20 gauge range.  What I want to focus on today is not the gauge, but rather the length of the catheters.

After you successfully cannulate the vein, the most important factors determining if it stays in (I.E., doesn’t extravasate/infiltrate/dislodge) are the length of the catheter and the distance of the vein from the surface.

Here’s the bottom line:

If the vein is <1 cm from the skin, standard IV length will probably be fine

If the vein is > 1 cm from the skin, you need a longer IV catheter.

Check out the video below for more specifics

  1. Jacob –
    Thanks for your podcasts.
    What do you do about the patients with highly mobile tissue planes above the vein? I’m talking about the little old ladies who get edematous forearms and have hammocks of flesh in their brachial areas. I can get the vein – and I use long catheters – but these IVs are so vulnerable to movement of the tissue above the vein. Any tips on dealing with those swimming seas of flesh?

    1. Thats a tough one. I make sure that a good amount of that catheter is in the vein. Besides that, securing the IV is paramount. I make sure all of the gel is completely off the skin (clean with gauze). Then I’m pretty aggressive with my taping. Additionally sometimes I use benzoin around the IV/where I’m taping after the gel has been taken off. That makes the tape stick even more.

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