Ultrasound Guidance as a Rescue Technique for Peripheral Intravenous Cannulation
UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD
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Peripheral intravenous IV cannulation can be difficult to perform using the traditional landmark or visualpalpation technique in patients with access difficulties such as deep, sclerotic, small, or fragile veins. Ultrasound guidance has shown efficacy in expediting the cannulation of central veins, but there is limited information on its utility in facilitating cannulation in peripheral veins, particularly for patients with difficult access. The purpose of this study was to compare the use of ultrasound guidance versus traditional technique for placing peripheral IVs in patients with difficult access. Patients were eligible for the study if they were over 18 years, not on steroid or anticoagulant therapy, required an 18 or 20 gauge IV, and had undergone two unsuccessful IV attempts by standard of care methods non-ultrasound. After informed consent, patients were randomized to either traditional or ultrasound IV insertion by one of three trained study anesthesia providers. Data collected included number of attempts to start an IV, time to cannulation, and patient perception of pain of the insertion 0- 10 scale. In addition patient age, gender, height, weight, and body mass index were recorded. A total of 18 useable subjects were enrolled with 6 subjects randomly assigned to the traditional group and 12 subjects to the ultrasound group. Analysis showed no significant difference between traditional and ultrasound techniques on minutes for insertion 11.3 8.5, vs. 13.913.2, p.670, patient pain perception 1.7.5 vs. 2.62A, p.227, or number of attempts 3.2 2.5 vs. 1.7.09, p.204.. However, power was low at under .43 for all comparisons. The results suggest that while ultrasound may require fewer attempts to cannulate, it is a potentially more painful and time consuming process.
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