PURPOSE: We evaluated the efficacy and safety of emergency department technicians' (EDT) use of ultrasound (US) guided peripheral intravenous (PIV) access compared to the traditional approach on a subset of patients with difficult IV access. METHODS: We enrolled a convenience sample of 75 ED patients with difficult IV access (at least 2 failed PIV attempts). During phase I, EDTs used the standard technique. EDTs then attended a didactic session on ultrasound guided PIV access of the upper extremity. In phase II, the EDTs used US guidance for PIV access. Outcome measures were successful PIV cannulation by an EDT, time to cannulation, medical doctor (MD) or registered nurseRN intervention, complications, patient satisfaction, and number of skin punctures. RESULTS: Successful cannulation rates were similar (US: 33/41, 80.5%; traditional technique: 24/34, 70.6%) (difference: 9.9%; 95% confidence interval (CI): -9.3%, 29.1%). US was 2.0 times faster (CI 1.3, 3.1), required less MD/RN intervention (7.3% vs. 20.6%) (difference: 13.3%; CI: -2.5, 30.2%), had fewer complications (41.5% vs. 64.7%, difference: 23.3%; CI 0.6%, 42.7%) and skin punctures (1.6 vs. 3.6; difference: 2.0; CI: 1.6, 2.7), and improved patient satisfaction from 4.4 to 7.7 cm (P-value = .0001). CONCLUSIONS: Following a brief US training for PIV access, EDTs showed similar success rates but US had significantly improved speed and patient satisfaction with fewer skin punctures and complications.
PURPOSE: We evaluated the efficacy and safety of emergency department technicians' (EDT) use of ultrasound (US) guided peripheral intravenous (PIV) access compared to the traditional approach on a subset of patients with difficult IV access. METHODS: We enrolled a convenience sample of 75 ED patients with difficult IV access (at least 2 failed PIV attempts). During phase I, EDTs used the standard technique. EDTs then attended a didactic session on ultrasound guided PIV access of the upper extremity. In phase II, the EDTs used US guidance for PIV access. Outcome measures were successful PIV cannulation by an EDT, time to cannulation, medical doctor (MD) or registered nurseRN intervention, complications, patient satisfaction, and number of skin punctures. RESULTS: Successful cannulation rates were similar (US: 33/41, 80.5%; traditional technique: 24/34, 70.6%) (difference: 9.9%; 95% confidence interval (CI): -9.3%, 29.1%). US was 2.0 times faster (CI 1.3, 3.1), required less MD/RN intervention (7.3% vs. 20.6%) (difference: 13.3%; CI: -2.5, 30.2%), had fewer complications (41.5% vs. 64.7%, difference: 23.3%; CI 0.6%, 42.7%) and skin punctures (1.6 vs. 3.6; difference: 2.0; CI: 1.6, 2.7), and improved patient satisfaction from 4.4 to 7.7 cm (P-value = .0001). CONCLUSIONS: Following a brief US training for PIV access, EDTs showed similar success rates but US had significantly improved speed and patient satisfaction with fewer skin punctures and complications.
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: Rasmus Jørgensen; Christian B Laursen; Lars Konge; Pia Iben Pietersen Journal: Scand J Trauma Resusc Emerg Med Date: 2021-06-27 Impact factor: 2.953
Authors: Catherine S Erickson; Michael M Liao; Jason S Haukoos; Erica Douglass; Margaret DiGeronimo; Eric Christensen; Emily Hopkins; Brooke Bender; John L Kendall Journal: West J Emerg Med Date: 2014-10-21