307 Ultrasonography-guided Peripheral Venous Access: A Systematic Review

Abstract

Study Objectives: A systematic review to compare the success rate of ultrasonography-guided peripheral intravenous access to traditional techniques in patients with difficult peripheral intravenous access Method: A systematic review protocol was created a priori by the investigators. A comprehensive search strategy was developed for Ovid MEDLINE and executed in the indexing languages of 4 databases. Four registries and 8 society conference proceedings were searched electronically using the same keyword search applied for Ovid MEDLINE. Field experts were contacted for unpublished studies or work in progress and reference of studies included for final reviews were searched manually for relevance. We included randomized controlled trials comparing ultrasonography-guided peripheral intravenous access to traditional techniques in patients of any age with difficult peripheral intravenous access. Studies were excluded if we were unable to obtain pertinent data through author contact, or if central venous access, external jugular vein access, or peripherally inserted central catheters were studied. Primary outcome measured successful peripheral intravenous access catheterization. Secondary outcomes included duration and number of attempts. Three authors performed the search, 2 authors independently scanned titles and abstracts for relevant studies that meet the inclusion criteria. Full text of any titles identified as relevant by any of the 2 authors were retrieved and independently abstracted into a standard data abstraction form. A third author arbitrated any difference. Based on the data abstraction form studies were selected for inclusion in final review. The PRISMA statement for reporting of systematic reviews was followed, and assessment of risk of bias was performed for all studies included for review. Results: 1570 titles resulted from the electronic search and 2 additional titles from grey literature search. 41 full text articles were retrieved and abstracted into the data abstraction form, 1531 titles were excluded after title and abstract review. Three articles were included in the final review for a total of 144 patients. The 3 studies took place in the operating suites and emergency departments. One study included pediatric subjects younger than 10 years of age. The randomized controlled trials found no difference in peripheral intravenous access success rate between ultrasonography and traditional techniques. No significant difference for procedure duration and number of attempts were found. Risk of bias was identified in one study with unknown concealment procedure and unknown intention to treat analysis. One other study contained missing outcome data or withdraws. Conclusion: Current evidence does not favor the use of ultrasonography over traditional techniques for difficult peripheral intravenous access. More randomized controlled trialss are needed to elucidate the benefit of ultrasonography guidance in peripheral intravenous access. Tabled 1