Ultrasound-Guided Peripheral Intravenous Access in the Emergency Department Using a Modified Seldinger Technique

Abstract

The utility of ultrasound-guided peripheral intravenous access (USGPIV) has been well described. However, few studies have investigated USGPIV techniques. To describe a modified Seldinger technique for USGPIV. Emergency Department patients with difficult i.v. access (three or more failed landmark attempts) were prospectively enrolled. USGPIV was attempted using modified Seldinger technique. A 20-gauge, 3.81-cm catheter with integral wire was used for all procedures. The basilic vein was identified using a high-frequency linear probe (5-10 MHz). The needle was inserted into the vein with dynamic guidance in short axis, and the cannula was advanced over a wire. Time from skin puncture to catheter insertion, number of needle sticks, and overall procedure time were recorded. Twenty-five patients were enrolled and underwent USGPIV; success rate was 96% (24/25). The mean number of needle sticks was 1.32 (95% confidence interval 1.12-1.52). Median time from skin to catheter insertion was 68 s (+/- SD 70.5 s). Median total procedure time was 7 min (420 s) (+/- SD 5.23 min). Modified Seldinger technique is an effective method of USGPIV and is worthy of a prospective comparison with non-Seldinger technique.