Ultrasound-guided peripheral intravenous access in adults: A randomized crossover controlled trial.

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Peripheral intravenous access is a common invasive clinical procedure, and difficult peripheral intravenous access is a common problem in the care of emergency and critically ill patients. The timeliness of immediate treatment is affected by the difficulty of intravenous access in clinical practice, which endangers patient safety. Repeated injections increase the pressure on nursing staff, consume more nursing hours, and incur higher medical costs. This study aimed to develop an evidence-based ultrasound-guided peripheral intravenous access protocol and evaluate the effectiveness of ultrasound guidance on difficult peripheral intravenous access. This was a randomized crossover study. This study enrolled 36 adult volunteers with difficult peripheral intravenous access at a medical center in southern Taiwan via convenience sampling. A randomized block design was used to generate random sequences. Each participant underwent ultrasound-guided and traditionally blind peripheral intravenous access. Ultrasound-guided peripheral intravenous access was performed using a high-frequency 12-MHz-ultrasound probe, and a two-person, dynamic, longitudinal, and transverse scanning method was adopted to help locate the position, direction, and depth of the peripheral veins. In this study, the chi-square test, Fisher's exact test, and independent t-test were used to compare post-test differences between the two groups. Ultrasound guidance significantly improved the first attempt success rate (odds ratio=10.97, p<0.0001) and overall success rate (odds ratio=49.67, p<0.0001) and reduced the number of attempts (mean difference=-0.50 attempts, p<0.0001) in difficult peripheral intravenous access. The ultrasound-guided peripheral intravenous access protocol developed in this study can significantly improve injection effectiveness in adults for whom intravenous access is difficult. A two-person, dynamic, longitudinal, and transverse scanning method is recommended in clinical practice to perform intravenous cannulation through rigorous ultrasound operation training to resolve the clinical problem of difficult intravenous access, reduce pressure on nursing staff, and improve the quality of clinical care. ISRCTN18025891.