STUDY OBJECTIVE: Standard length (3 to 5 cm) intravenous catheters in the deep brachial or basilic vein tend to dislodge prematurely. We assess the safety and longevity of a 15-cm catheter inserted in these veins by a novel ultrasonographically guided technique. METHODS: This is a prospective cohort study conducted in an urban teaching emergency department (ED). Adult subjects were enrolled if 2 peripheral intravenous insertion attempts had failed. A 3.2-cm, 18-gauge catheter was first inserted into the deep brachial or basilic vein under ultrasonographic guidance. In a separate step, a wire was inserted through this catheter, and a 15-cm, 16-gauge catheter was placed over the wire and left in place for up to 3 days. Primary outcomes were time to securing access and rate of loss of access. Secondary outcomes included complication rates and subject satisfaction. RESULTS: Twenty-five subjects were enrolled; 23 catheters were successfully placed. Median time required for initial vein cannulation was 3 minutes (interquartile range [IQR] 2 to 7 minutes) and for securing the 15-cm catheter was an additional 4 minutes (IQR 3 to 5 minutes). Median duration of access was 26 hours (IQR 10 to 47 hours). The only complication was early infiltration in 1 subject. All subjects rated satisfaction as 4 or 5 on a 5-point Likert scale. CONCLUSION: We present a promising alternative to central venous catheterization in patients with difficult intravenous access. This technique appears to be fast, safe, and well tolerated by adult patients.
STUDY OBJECTIVE: Standard length (3 to 5 cm) intravenous catheters in the deep brachial or basilic vein tend to dislodge prematurely. We assess the safety and longevity of a 15-cm catheter inserted in these veins by a novel ultrasonographically guided technique. METHODS: This is a prospective cohort study conducted in an urban teaching emergency department (ED). Adult subjects were enrolled if 2 peripheral intravenous insertion attempts had failed. A 3.2-cm, 18-gauge catheter was first inserted into the deep brachial or basilic vein under ultrasonographic guidance. In a separate step, a wire was inserted through this catheter, and a 15-cm, 16-gauge catheter was placed over the wire and left in place for up to 3 days. Primary outcomes were time to securing access and rate of loss of access. Secondary outcomes included complication rates and subject satisfaction. RESULTS: Twenty-five subjects were enrolled; 23 catheters were successfully placed. Median time required for initial vein cannulation was 3 minutes (interquartile range [IQR] 2 to 7 minutes) and for securing the 15-cm catheter was an additional 4 minutes (IQR 3 to 5 minutes). Median duration of access was 26 hours (IQR 10 to 47 hours). The only complication was early infiltration in 1 subject. All subjects rated satisfaction as 4 or 5 on a 5-point Likert scale. CONCLUSION: We present a promising alternative to central venous catheterization in patients with difficult intravenous access. This technique appears to be fast, safe, and well tolerated by adult patients.
Authors: Giancarlo Scoppettuolo; Mauro Pittiruti; Sara Pitoni; Laura Dolcetti; Alessandro Emoli; Alessandro Mitidieri; Ivano Migliorini; Maria Giuseppina Annetta Journal: Int J Emerg Med Date: 2016-02-04
Authors: Peter J Carr; James C R Rippey; Marie L Cooke; Chrianna Bharat; Kevin Murray; Niall S Higgins; Aileen Foale; Claire M Rickard Journal: BMJ Open Date: 2016-02-11 Impact factor: 2.692
Authors: Lukasz Szarpak; Zenon Truszewski; Jacek Smereka; Paweł Krajewski; Marcin Fudalej; Piotr Adamczyk; Lukasz Czyzewski Journal: Medicine (Baltimore) Date: 2016-05 Impact factor: 1.889