3. Pre-Procedure scan for US-Guided PIV

Identify Surrounding Structures

Don’t hit an artery or nerve..

Notice how close the Deep Brachial Vein is associated with the Brachial artery. It is important to correctly map out the vein and note any surrounding structures to avoid accidentally injuring a nearby nerve or puncturing an artery. The Median nerve will appear as a honeycomb structure that may be above or below the vessels.

Ultrasound Guided Peripheral IV PIV Annotated
3. Pre-Procedure scan for US-Guided PIV

Identify the Depth of your Vein


To measure the depth the vein is beneath the skin, you can use the cm markers on the right side of the screen to determine the depth of the vein. This will be helpful when determining how far you should insert the needle before reaching the vein.

Ultrasound Guided Peripheral IV PIV Correct Depth
3. Pre-Procedure scan for US-Guided PIV

Identify a Target Vein on Ultrasound

With the ultrasound Linear array probe in Left hand, apply surgilube to the transducer with your Right hand. Identify the target veins and visualize the surrounding structures.

  1. Map out the vein you are cannulating by scanning up and down a few centimeters to know anatomy and direction of the vein & making a mental note of any valves, arteries and nerves.
  2. Double check by compressing the vein by adding pressure with the transducer causing the vein to collapse. If the vein is compressible you know it is patent.
  3. Start at a location distal to the target vein and proceed to scan more proximally. By starting distally and proceeding proximally, you will be able to visualize the trajectory the vein is traveling.
3. Pre-Procedure scan for US-Guided PIV

Pre-Procedure scan for US-Guided PIV

Choosing a Target Vein

First, look for the cephalic vein and basilic vein in the upper extremity. If you are unable to locate either of these veins, use the deep brachial vein as a last resort. Avoid the deep brachial if possible because it is a larger vein that is commonly used for PICC lines or other accesses. Although the median cubital vein is considered a superficial vein that can be cannulated, it is best to avoid this vein because it is at the crease of the joint and can easily be occluded when the patient is flexing their elbow.

Here are some questions you can ask yourself while choosing the target vein:

  • Where is the Target vein?
  • Is the Target vein Patent?
  • Is the course of the vein straight enough to insert a catheter?
  • What is the depth of my vein?
  • Are there any surrounding structures (arteries, nerves)?