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Standardized Ultrasound-Guided PIV Insertions Improve Outcomes and Reduce Costs

By MedImaging International staff writers
Posted on 06 Oct 2022

The use of ultrasound raises significant challenges: the presence of both the ultrasound probe and gel on at the sterile insertion site can contribute to contamination. More...

In addition, gel requires difficult clean up, and any gel left on the skin reduces the adherence of the dressing, increasing the chances of dressing failure. Now, a new study has shown that standardizing ultrasound-guided peripheral intravenous (PIV) insertions in a hospital setting using an innovative sterile barrier dressing reduced costs by 73% and staff time for insertions by 50%, while also improving both patient and nursing staff satisfaction.

The study by PICC Excellence (St Hartwell, GA, USA) was done at a medium-sized hospital with 245 beds and an emergency department that sees about 160 patients per day. A five-member vascular access team manages about 90 ultrasound-guided insertions per month. As part of a quality improvement initiative, researchers evaluated existing procedures for ultrasound-guided PIV insertions. They found significant procedural and supply variations among the departments. While the hospital did consistently use a Central Line Dressing Kit for each insertion, researchers observed that inserters wasted some of the more expensive components of the Kit. In addition, patients reported dissatisfaction because some insertions required multiple attempts.

To test possible solutions to these problems, the hospital switched to a standardized approach using an intravenous Start Kit with a sterile barrier ultrasound dressing called UltraDrape from Parker Laboratories Inc. (Fairfield, NJ, USA). In the standardized procedure, inserters first mark the selected site and apply the folded UltraDrape dressing to the skin. The ultrasound gel is applied to the back side of the dressing for ultrasound probe position and guidance during the insertion. Finally, the gel layer of the dressing is lifted off, and the dressing pulled down over the catheter, creating a sterile transparent dressing cover.

When the hospital switched to the standardized procedure, the data collected demonstrated impressive results. The average cost of supplies per insertion dropped from USD 25.32 to USD 6.71, which would add up to savings of more than USD 20,000 per year. In addition, the time required for each insertion was reduced from 6.51-12.14 minutes to just 3.2-4.25 minutes. Moreover, both patients and staff reported being far happier because of quicker insertions and fewer failed attempts. UltraDrape is simple to use, cost effective and faster than using standard probe covers. Using ultrasound to guide PIV insertions also improves the success rate for insertions, especially for patients with more co-morbidities requiring special skill with visualization technology.

“Our study shows that it is possible to improve outcomes and procedures for ultrasound-guided PIV insertions while also significantly cutting costs and staff time and reducing waste,” said Dr. Nancy Moureau, CEO of PICC Excellence and an internationally recognized expert and consultant in vascular access. “These results suggest that hospitals should consider more widespread use of the standardized UltraDrape dressing procedure.”

“It is the only dressing that separates the gel from the insertion site and that removes the gel after insertion, while providing sterile probe protection,” added Moureau. “For the estimated 12 million ultrasound-guided PIV insertions done each year in North America, it offers a win-win solution, simplifying and speeding up the procedure while reducing costs and time.”

“The UltraDrape dressing enables a level of standardization that simplifies the procedure while ensuring that sterile conditions are maintained,” said co-author Pam Pressnall. “This helped us achieve a level of efficiency that allows us to perform more ultrasound-guided patient insertions in fewer attempts, resulting in happier patients and nursing staff.”

Related Links:
PICC Excellence
Parker Laboratories Inc.

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57 (431.06079101562): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294794841 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

58 (!!!!! 4573.8220214844): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794841 AND published='1' LIMIT 1

59 (88.930130004883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794841 AND published='1' LIMIT 1

60 (150.20370483398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794841 AND published='1' LIMIT 1

61 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794841 AND published='1' LIMIT 1

62 (113.96408081055): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

63 (523.09036254883): SELECT fid FROM jos_deeppockets WHERE id=294794841 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294794841 AND published='1' LIMIT 1

64 (51.021575927734): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=214 ORDER BY `ordering`

65 (68.187713623047): select jos_twitters.link from jos_twitters where cat=10

66 (34.809112548828): select jos_facebook.link from jos_facebook where cat=10

67 (34.093856811523): select jos_google_plus.link from jos_google_plus where cat=10

68 (30.994415283203): select jos_linkedin.link from jos_linkedin where cat=10

69 (42.915344238281): SELECT fid FROM jos_deeppockets WHERE id=294794841 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294794841 AND published='1' LIMIT 1

70 (36.001205444336): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=214 ORDER BY `ordering`

71 (356.19735717773): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294794841 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (335.9317779541): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294794841 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (45.061111450195): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

74 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (66.995620727539): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294794841 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (66.995620727539): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294794841 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (44.107437133789): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

91 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (79.154968261719): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794841 AND published='1' LIMIT 1

106 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794841 AND published='1' LIMIT 1

107 (83.92333984375): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294794841 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (68.902969360352): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294794841 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794841 AND published='1' LIMIT 1

110 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794841 AND published='1' LIMIT 1

111 (51.021575927734): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294794841 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (471.11511230469): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294794841 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (592.94700622559): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (322.10350036621): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

115 (95.129013061523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794841 AND published='1' LIMIT 1

116 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794841 AND published='1' LIMIT 1

117 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794841 AND published='1' LIMIT 1

118 (38.14697265625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794841 AND published='1' LIMIT 1

119 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794841 AND published='1' LIMIT 1

120 (38.14697265625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794841 AND published='1' LIMIT 1

121 (42.200088500977): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794841 AND published='1' LIMIT 1

122 (37.908554077148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794841 AND published='1' LIMIT 1

123 (422.00088500977): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294794841 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294794841 AND type='deeppockets_item' AND published='1' LIMIT 1

124 (!!!!! 7885.9329223633): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

125 (84.877014160156): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (59.843063354492): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

127 (88.930130004883): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (90.837478637695): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

129 (31.948089599609): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (269.88983154297): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

131 (101.08947753906): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (38.14697265625): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

133 (28.848648071289): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (410.07995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (289.2017364502): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794841 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (80.108642578125): SELECT name FROM jos_deeppockets WHERE id=214

137 (35.04753112793): SELECT name FROM jos_deeppockets WHERE id=214

138 (767.94624328613): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

139 (483.98971557617): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (73.19450378418): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794841 AND published='1' LIMIT 1

141 (50.783157348633): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794841 AND published='1' LIMIT 1

142 (322.81875610352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

143 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

144 (70.810317993164): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794841 AND published='1' LIMIT 1

145 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794841 AND published='1' LIMIT 1

146 (!!!!! 1303.9112091064): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

147 (59.843063354492): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794841 AND published='1' LIMIT 1

148 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794841 AND published='1' LIMIT 1

149 (35.04753112793): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294794841 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294794841 AND type='deeppockets_item' AND published='1' LIMIT 1

150 (32.901763916016): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=214 or channel_id is null)

151 (30.040740966797): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=214 or channel_id is null)

152 (31.948089599609): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

153 (176.19132995605): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794841 AND published='1' LIMIT 1

154 (84.877014160156): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794841 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794841 AND published='1' LIMIT 1

155 (46.014785766602): select jos_twitters.link from jos_twitters where cat=10

156 (37.908554077148): select jos_facebook.link from jos_facebook where cat=10

157 (38.862228393555): select jos_google_plus.link from jos_google_plus where cat=10

158 (39.100646972656): select jos_linkedin.link from jos_linkedin where cat=10

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