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Ultrasound for Peripheral Intravenous Access

As it does for central lines, ultrasound increases success in difficult peripheral intravenous cannulation.

Use of emergency ultrasound to guide procedures, including central venous access, is rapidly becoming standard in emergency medicine. Yet, little is known about the utility of ultrasound for guiding peripheral intravenous (IV) access. In a prospective, randomized, controlled study, researchers assessed this technique in patients presenting with predictors of difficult IV access.

Patients were eligible for the study if they had a history of difficult peripheral IV access due to obesity, IV drug use, or chronic medical problems and if nurses could not establish peripheral IV access after three attempts. Of the 60 enrolled patients, 21 were randomized to standard therapy, in which physicians or nurses attempted IV access using landmark and palpation approaches, and 39 were randomized to ultrasound-guided IV access.

The ultrasound group had a higher success rate than the control group (97% vs. 33%), shorter time to successful cannulation (13 vs. 30 minutes), and fewer percutaneous punctures (1.7 vs. 3.7).

Comment: Here is another potentially valuable use of ultrasound in the ED. Its proven benefits for central venous access seem to extend to difficult peripheral-vein cannulation, too. Perhaps we should consider going straight to ultrasound guidance for all patients with difficult access, thereby sparing patients undue pain. Combining ultrasound guidance with local anesthesia might even make IV insertion relatively painless.

— Richard D. Zane, MD, FAAEM

Published in Journal Watch Emergency Medicine January 4, 2006

Citation(s):

Costantino TG et al. Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access. Ann Emerg Med 2005 Nov; 46:456-61.

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