Ultrasonographically Guided Peripheral Intravenous Cannulation in Emergency Department Patients With Difficult Intravenous Access: A Randomized Trial
Presented as an abstract at the Society of Academic Emergency Medicine meeting, May 2005, New York, NY.
Received 18 June 2007; received in revised form 6 February 2008 and 9 June 2008; accepted 29 July 2008. published online 29 September 2008.
Study objective
We seek to compare ultrasonographically guided peripheral intravenous access to a non–ultrasonographically guided method in a randomized trial of emergency department patients with difficult intravenous access.
Methods
A prospective cohort of patients with difficult intravenous access was established. Patients were randomized to 2 groups: (1) intravenous access obtained through an ultrasonographically guided technique or (2) intravenous access obtained through non–ultrasonographically guided methods. Outcomes measured were number of attempts after enrollment, time to cannulation from enrollment, and patient satisfaction. Groups were compared with nonparametric analysis.
Results
Fifty-nine patients were randomized. Twenty-eight patients were randomized to the ultrasonography group and 31 to the no ultrasonography group. A median of 2 further intravenous attempts was required in each group before successful cannulation, corresponding to a difference of 0 attempts (95% confidence interval [CI] 0 to 1 attempts). Time to cannulation showed a median of 39 minutes in the ultrasonography group compared with 26 minutes for the no ultrasonography group, giving a median increase of 13 minutes for the ultrasonographically guided group (95% CI –5 to 28 minutes). Patients in the ultrasonography group had a median Likert satisfaction score of 8 compared with 7 for the no ultrasonography group, giving a median increase of 1 on this scale in the ultrasonography group (95% CI 0 to 2).
Conclusion
Ultrasonographically guided peripheral intravenous cannulation did not decrease the number of attempts or the time to successful catheterization, nor did it improve patient satisfaction compared with the group that did not use ultrasonography. Superiority of ultrasonographically guided peripheral intravenous cannulation is not supported by this study.
University of California, San Francisco, Emergency Department, San Francisco, CA
Address for correspondence: John Stein, MD, University of California, San Francisco, Emergency Department, Box 0208, 505 Parnassus, San Francisco, CA 94143; 415-353-1634
Dr. Callaham recused himself from the decision process for this article.
Author contributions: JS, BG, and DM conceived the study and designed the trial. JS, BG, and DM supervised the conduct of the trial and data collection. JS provided statistical advice on study design and analyzed the data. JS drafted the article, and all authors contributed substantially to its revisions. JS and DM take responsibility for the paper as a whole.
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ABSTRACT