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Abstract
(1) Objective. We aimed to demonstrate that the use of the ultrasound-guided technique facilitates peripheral venous cannulation as compared to the standard technique in patients with difficult access at emergency services. (2) Method. A case–control study, randomized research. Variables were collected from a population with non-palpable or not visible veins, classified into size risk groups for 6 months. In the comparative analysis, the patients were divided into two groups: the cases group was composed of patients to whom the peripheral venous cannulation was performed with the ultrasound-guided technique (UST), while the control was composed of patients with whom the standard technique (ST) was performed. The ultrasound LOGIQ P5 750VA from General Electric Healthcare, with an 11 mHz linear probe, was utilized, along with peripheral venous catheters model InsyteTM AutoguardTM with gauges of 14G to 26G. (3) Results. Seventy-two cases. The use of the ultrasound decreased the time (618.34s ST, 126s UST) and the number of punctures (2.92 ST, 1.23 UST); about 25% of the patients did not have complications with the UST, as compared to 8% with the ST. The use of the ultrasound decreased the pain experienced by 1.44 points in the visual analog scale, as compared to 0.11 points with the ST. The rate of success of the first try with the UST was 76%, as compared to 16% of the ST. The gauge of the catheter increased with the UST, with successful cannulations obtained with 20G (56%) and 18G (41%) gauges. (4) Conclusions. The use of ultrasound facilitates venous cannulation according to the variables of the study. The ultrasound visualization of the vessels is associated with the selection of the catheter gauge. There was no relation between the complications and the depth of the blood vessels.
Highlights
Peripheral venous cannulation is a very common technique utilized for diagnosis and therapeutic aims, one that is considered a fast, safe, and easy-to-perform technique.Among its advantages, we find the simplicity of its placement and only a small number of associated complications, with an estimated number of 90% of patients with a peripheral venous device at Emergency Services (ES)
It was observed that the only variable which showed a significant difference between the two techniques was BMI, which was greater in the group in which the ultrasound technique was utilized
When analyzing the studies in which significant differences were not found with respect to the number of tries [23,24,25], we found that they did point to an improvement in the rest of the variables through the use of US; morever, none of them pointed to more than three tries until successful cannulation, which coincides with our data
Summary
Peripheral venous cannulation is a very common technique utilized for diagnosis and therapeutic aims, one that is considered a fast, safe, and easy-to-perform technique. We find the simplicity of its placement and only a small number of associated complications, with an estimated number of 90% of patients with a peripheral venous device at Emergency Services (ES). With patients with difficult venous access, other more sophisticated techniques or alternative manners of performing this technique are needed to ensure good quality care [1]. A large number of patients are usually treated at ES, of which a large percentage will have a difficult venous access. Other factors must be considered, such as the depth of the vessels or the prior pathologies of the patient, which will have an influence on their vascular capital, or even vasoconstriction due to the cold, hypotension, or shock, as well as in any other technique, the knowledge and experience of the person performing it [2,3]
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