Abstract
Successful placement of a peripheral intravenous catheter (PIVC) on the first attempt is an important outcome for difficult vascular access (DVA) patients. This study compared standard technique, ultrasonography (USG), and near-infrared light (NIR) in terms of success in the first attempt in patients with DVA. This was a prospective, randomized controlled study. The study was conducted in a tertiary care hospital. Emergency department patients who describe DVA history, have no visible or palpable veins, and were assessed by the nurse to have a difficult PIVC were included to study. The PIVC procedure was performed on patients by standard, USG, or NIR device techniques. For all approaches, the success of the first attempt was the primary aim. Total procedure time, the total number of attempts, and the need for rescue intervention were secondary aims. This study evaluated 270 patients. The first attempt success rates for USG, standard, and NIR methods were 78.9%, 62.2%, and 58.9%, respectively. The rate of first attempt success was higher in patients who underwent USG (USG versus standard, P = .014; USG versus NIR, P = .004; standard versus NIR, P = .648). The total median (IQR) procedure time for USG, standard, and NIR methods was 107 (69-228), 72 (47-134), and 82 (61-163) seconds, respectively. The total procedure time was longer in patients undergoing USG (standard versus USG, P <.001; NIR versus USG, P = .035; standard versus NIR, P = .055). The total median (IQR) number of attempts of USG, standard, and NIR methods were 1 (1-1), 1 (1-2), and 1 (1-2), respectively. A difference was found among the groups regarding the total number of attempts (USG versus NIR, P = .015; USG versus standard P = .108; standard versus NIR, P = .307). No difference was found among groups in terms of the need for rescue methods. It was found that USG increases the success of the first attempt compared with the standard method and NIR in patients with DVA.
Highlights
Peripheral intravenous catheterization (PIVC) is a frequently performed procedure in emergency medicine practice
Objectives: Successful placement of a peripheral intravenous catheter (PIVC) on the first attempt is an important outcome for difficult vascular access (DVA) patients
This study found that the first attempt success rate was higher in the ultrasound group than the standard and near-infrared light (NIR) groups
Summary
Peripheral intravenous catheterization (PIVC) is a frequently performed procedure in emergency medicine practice. Performing procedures on the first attempt is important to reduce patients’ pain and anxiety and increase trust in health care personnel. Difficult vascular access (DVA) is often described as a failure to obtain vascular access after two unsuccessful attempts.[1,2,3,4,5] Patients with non-visible and non-palpable veins, who describe a DVA history based on previous hospital admissions, and are assessed by the experienced nurse as a challenging procedure are presumed to be difficult PIVC.[6,7]. In case of failure in these, they can seek help from a more experienced health care professional or try again from different anatomical locations.[8] Another approach with an increasing frequency of application in recent years is bed-side ultrasonography (USG). With the advances in technology, one of the Prehospital and Disaster Medicine
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