Abstract
BackgroundStudies have shown that vein size is an important predictor of successful ultrasound-guided vascular access. The objective of this study is to evaluate maneuvers designed to increase basilic vein size, which could be used to facilitate ultrasound-guided peripheral intravenous access (USGPIV) in the Emergency Department (ED) setting.MethodsThis was a prospective non-randomized trial. Healthy volunteers aged 18-65 were enrolled. Basilic veins were identified and the cross-sectional area measured sonographically. Following baseline measurement, the following maneuvers were performed: application of a tourniquet, inflation of a blood pressure (BP) cuff, application of a tourniquet with the arm lowered, and BP cuff inflation with the arm lowered. Following each maneuver there was 30 s of recovery time, and a baseline measurement was repeated to ensure that the vein had returned to baseline. Change in basilic vein size was modeled using mixed model analysis with a Tukey correction for multiple comparisons to determine if significant differences existed between different maneuvers.ResultsOver the 5-month study period, 96 basilic veins were assessed from 52 volunteers. All of the maneuvers resulted in a statistically significant increase in basilic vein size from baseline (p < 0.001). BP cuff inflation had the greatest increase in vein size from baseline 17%, 0.87 mm 95% CI (0.70-1.04). BP cuff inflation statistically significantly increased vein size compared to tourniquet placement by 3%, 0.16 mm 95% CI (0.02-0.30).ConclusionsThe largest increase in basilic vein size was due to blood pressure cuff inflation. BP cuff inflation resulted in a statistically significant increase in vein size compared to tourniquet application, but this difference may not be clinically significant.
Highlights
Studies have shown that vein size is an important predictor of successful ultrasound-guided vascular access
Application of a tourniquet with the arm supported at the level of the heart increased size by 14%, a difference of 0.71 mm 95% CI (0.55, 0.88), p < 0.001
Inflation of a blood pressure cuff above diastolic pressure, with the arm supported at the level of the heart, increased basilic vein diameter by 17%, 0.87 mm 95% CI (0.70-1.04), p < 0.001
Summary
Studies have shown that vein size is an important predictor of successful ultrasound-guided vascular access. The objective of this study is to evaluate maneuvers designed to increase basilic vein size, which could be used to facilitate ultrasound-guided peripheral intravenous access (USGPIV) in the Emergency Department (ED) setting. Prior to ultrasound-guided peripheral intravenous access (USGPIV), patients with failed landmark techniques often. Studies have shown that vein size is an important predictor of successful ultrasound-guided vascular access [8,9]. The objective of this study is to evaluate maneuvers practical for ED use that could be utilized to improve the success of USGPIV by increasing basilic vein size
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