A Randomized Controlled Trial Comparing One-Operator Versus Two-Operator Technique in Ultrasound-Guided Basilic Vein Cannulation

Abstract

The basilic vein offers an alternative site for peripheral intravenous access for emergency access. The use of a two-operator ultrasound-guided basilic vein cannulation technique has been shown to be a safe and effective technique for use on Emergency Department patients. However, the one-operator technique is more customary by other services. We sought to compare the more customary one-person technique to the two-person technique in basilic vein cannulation in novice operators. This was a prospective, randomized controlled trial of two techniques of ultrasound-guided basilic vein cannulation (one-operator vs. two-operators) in healthy adult volunteers. Each volunteer underwent each technique, one technique on each arm. We selected the initial arm and technique using computer-generated block randomization. In the one-operator technique, a single operator held the transducer in transverse short-axis plane while attempting cannulation using a 20-gauge, 1.88-inch catheter. In the two-operator technique, a second operator held the transducer in place while the first operator attempted cannulation. The primary outcome variable was first-attempt cannulation success. Secondary outcome variables were overall success, number of attempts, time-to-cannulation, complications, and ease-of-technique rated by the operators. There were 32 subjects enrolled. One-operator first-attempt success was 18/32 (56%); two-operator was 21/32 (65%), with a mean difference in proportion of −9% (95% confidence interval [CI] −33–14%). Overall success for one operator was 23/32 (72%) and two-operator was 24/32 (75%), with mean difference in proportion of −3% (95% CI −24–18). The median number of attempts for one-operator was 1.6 (interquartile range [IQR] 1–5) and two-operator was 1.4 (IQR 1–5) ( p = 0.8). Time to cannulation for one-operator was 57 s (± 62) and two-operator was 44 s (± 37) ( p = 0.33). The median score for ease-of-technique for one-operator was 4.3 (IQR 1–6) and for two-operator was 3.6 (IQR 1–6) ( p = 0.26). There were no complications with either technique (95% CI 0–10%). Novice operators can reliably perform a basilic vein cannulation using ultrasound guidance. However, we were unable to demonstrate any advantage for any particular technique in cannulating the basilic vein.