Ultrasound-guided Peripheral Intravenous Access Research Articles

AIUM Official Statement: Guidelines for Cleaning and Preparing External- and Internal-Use Ultrasound Transducers and Equipment Between Patients as Well as Safe Handling and Use of Ultrasound Coupling Gel.

AIUM Official Statement: Guidelines for Cleaning and Preparing External- and Internal-Use Ultrasound Transducers and Equipment Between Patients as Well as Safe Handling and Use of Ultrasound Coupling Gel.

Use of point of care ultrasound (POCUS) by intensive care paramedics to achieve peripheral intravenous access in patients predicted to be difficult: An out-of-hospital pilot study

IntroductionIntravenous cannulation is a common procedure for paramedics. Difficulty is often encountered and may result in escalation of care to an intensive care paramedic (ICP). Ultrasound-guided peripheral intravenous access (USGPIVA) is used in-hospital as an alternative approach. Historically limited to physicians, it is increasingly embraced by non-physicians, with point of care ultrasound (POCUS) devices more affordable, portable, and suited to the out of hospital environment. ObjectiveTo explore the utility of ICP-performed USGPIVA for patients who are predicted to be difficult according to a difficult intravenous access scoring tool. MethodsThis was a prospective observational pilot study of ICPs who used the adult difficult intravenous access (A-DIVA) scale to predict difficulty and perform USGPIVA using a contemporary POCUS device. ResultsFor the 32 patients enroled, the overall success rate was 50% of which 87% were successful on the first attempt. Mean A-DIVA score was 4.1/5, and paradoxically, success improved with A-DIVA-predicted difficulty. ConclusionICPs can perform USGPIVA with moderate success. The A-DIVA score could be useful for paramedics to predict difficult cannulation. Future research should focus on increasing exposure, training time and enhancing feedback to paramedics performing USGPIVA.

Can Non-Physician Providers Use Ultrasound to Aid in Establishing Peripheral IV Access in Patients Who are Difficult to Cannulate? A Scoping Review.

Non-physician performed point-of-care ultrasound (POCUS) is emerging as a diagnostic adjunct with the potential to enhance current practice. The scope of POCUS utility is broad and well-established in-hospital, yet limited research has occurred in the out-of-hospital environment. Many physician-based studies expound the value of POCUS in the acute setting as a therapeutic and diagnostic tool. This study utilized a scoping review methodology to map the literature pertaining to non-physician use of POCUS to improve success of peripheral intravenous access (PIVA), especially in patients predicted to be difficult to cannulate. Ovid MEDLINE, CINAHL Plus, EMBASE, and PubMed were searched from January 1, 1990 through April 15, 2021. A thorough search of the grey literature and reference lists of relevant articles was also performed to identify additional studies. Articles were included if they examined non-physician utilization of ultrasound-guided PIVA (USGPIVA) for patients anticipated to be difficult to cannulate. A total of 158 articles were identified. A total of 16 articles met the inclusion criteria. The majority of participants had varied experience with ultrasound, making accurate comparison difficult. Training and education were non-standardized, as was the approach to determining difficult intravenous access (DIVA). Despite this, the majority of the studies demonstrated high first attempt and overall success rates for PIVA performed by non-physicians. Non-physician USGPIVA appears to be a superior method for PIVA when difficulty is anticipated. Additional benefits include reduced requirement for central venous catheter (CVC) or intraosseous (IO) needle placement. Paramedics, nurses, and emergency department (ED) technicians are able to achieve competence in this skill with relatively little training. Further research is required to explore the utility of this practice in the out-of-hospital environment.

Biplane Imaging Versus Standard Transverse Single-Plane Imaging for Ultrasound-Guided Peripheral Intravenous Access: A Prospective Controlled Crossover Trial.

OBJECTIVES:Obtaining peripheral IV access in critically ill patients is often challenging especially for novice providers. The availability of biplane imaging for ultrasound guided peripheral access has the potential to improve successful venous cannulation compared with standard plane imaging.DESIGN:Single-center quasi-randomized (alternate allocation) crossover trial.SETTING:Surgical ICU at the Massachusetts General Hospital.SUBJECTS:Twenty surgical ICU nurses with no prior experience using ultrasound for peripheral IV were enrolled.INTERVENTIONS:All participants viewed instructional videos on single-plane and biplane imaging for peripheral IV insertion. The participants were then quasi-randomly assigned to use either single-plane or biplane imaging for peripheral IV insertion using a phantom model. The time to catheter completion, successful lumen cannulation, and attempts in which the needle was observed to go through the back wall of the vessel were recorded for each of the three attempts. The following day the participants repeated the peripheral IV insertion with the alternate imaging modality.MEASUREMENTS AND MAIN RESULTS:Biplane imaging compared with single-plane imaging was associated with a significantly greater overall success rate (78.3% ± 22.4% vs 41.7% ± 26%; p < 0.001), higher first-pass success rate (80% ± 41% vs 45% ± 51%; p = 0.015), faster cannulation times (27.8 ± 14.8 vs 36.6 ± 15.8 s; p = 0.003), and reduced frequency of backwall perforations (0.4 ± 0.7 vs 1.5 ± 0.8; p < 0.001).CONCLUSIONS:This proof-of-principle study demonstrates that the biplane ultrasound imaging approach for vessel cannulation resulted in an overall faster, more successful, and safer peripheral IV access than the standard single-plane transverse approach when performed by novice ultrasound users.

Continuing Education for the Certified Registered Nurse Anesthetist: Ultrasound-Guided Peripheral Intravenous Access.

Vascular access is critical in the perioperative arena and is a requirement for most surgical procedures. The goals of this project were to increase knowledge among certified registered nurse anesthetists (CRNAs) by providing a focused didactic and simulation course on ultrasound-guided peripheral intravenous access and to assess the confidence and comfort levels of performing ultrasound-guided peripheral intravenous access before and after the course. A combined didactic and simulation ultrasound-based education course was developed to train CRNAs in ultrasound-guided peripheral intravenous access. The training module consisted of a didactic presentation followed by a simulation with fabricated and human models. All participants showed competency during the training course by identifying upper extremity and lower extremity sonographic vascular anatomy on a human model and performing ultrasound-guided intravenous access on fabricated models. Mean correct pretest response was 1.57 (95% confidence interval) compared with 3.53 (95% confidence interval) on the posttest. The findings show improvement in performance of ultrasound-guided peripheral intravenous access by CRNAs after a focused ultrasound education session. [J Contin Educ Nurs. 2021;52(10):489-492.].

Ultrasound-guided peripheral intravenous access in chronic kidney disease patients.

Ultrasound-guided peripheral intravenous (USPIV) catheters are being placed in emergency department (ED) patients with increasing frequency. USPIV catheters have been shown to improve the success rates of cannulation. It is unknown what the long-term effect of USPIV placement will be on fistula creation in chronic kidney disease (CKD) patients considering these ultrasound-guided peripheral lines often target the same deeper vessels used for fistulas. This study aimed to survey whether emergency medicine programs place restrictions on USPIV placement in patients with CKD stages 3-5. This was a survey study encompassing all 110 emergency ultrasound fellowship directors in the United States at the time the survey was conducted. Data was collected on an anonymous and voluntary basis. The primary outcome was the number of programs with restrictions on USPIV placement in patients with CKD stage 3 or greater. Of the 56 programs that responded, 21% reported having policies limiting which patients were appropriate for USPIV. Despite this, only one program reported placing restrictions on USPIV in CKD stage 3 or greater (p < 0.0001). Emergency departments do not have or follow restrictions placed on USPIV placement in patients with CKD stage 3 or greater. The use of these veins in the ED may result in thrombosis as well as inflammation and permanent scarring which could negatively impact the ability to utilize those vessels for fistula creation. Future studies are needed to further characterize the impact of USPIV on fistula creation.

First-Attempt Success Rate of Ultrasound-Guided Peripheral IV Access using a Handheld Ultrasound Machine in a Simulation Model

Background: Although peripheral Intravenous (IV) cannulation is a routine procedure performed by nurses, IV access can be difficult to achieve, particularly in emergency patients who have critical illnesses. Ultrasound is used in this procedure to increase the success rate in novice practitioners. Objective: We aimed to determine the first-attempt success rate of ultrasound-guided peripheral IV (USGPIV) performed by emergency nurses in simulation model after having undergone training in the procedure. Materials and Methods: This was prospective descriptive study. The participants consisted of 61 emergency nurses at Srinagarind Hospital Emergency Department from January to April 2020. USGPIV cannulation training was provided by an emergency physician who is also a specialist in emergency ultrasound. After training, we calculated the number of attempts and time required to successfully complete USGPIV in a simulation model. Following this, participants responded to a questionnaire to evaluate their confidence in performing the procedure, as well as its feasibility and practical application. Data were analyzed using a Kolmogorov-Smirnov test, and p&lt;0.05 was considered to be significant. Results: Sixty-one emergency nurses were included. The first-attempt success rate of USGPIV was 85.25% (95% CI 0.761, 0.944), and the mean time required was 47.33+4.89 sec. (95% CI 37.547, 57.103). Fifty-nine participants (96.72%) completed the questionnaire. All items had a mean score of greater than 3 points, with confidence score being the highest. Conclusion: Emergency nurses with no previous experience with USGPIV were able to perform a simulated version of the procedure with a high first-attempt success rate after a short training session. Further studies should be conducted to evaluate nurses’ USGPIV competency in real patients. Keywords: Ultrasound, Peripheral IV cannulation, Emergency medicine, Emergency nurse

A-DIVA Score and the Implementation of the Use of Ultrasound-Guided Peripheral Intravenous Access in the Emergency Department: A Brief Literature Review

Background: Peripheral intravenous (PIV) access is performed daily in the emergency department (ED). Difficult to access patients receive multiple intravenous attempts prior to successful cannulation. USGPIVA is a noninvasive technique to improve successful cannulation with the first attempt on a difficult to access patient. Use of the A-DIVA scoring method may determine difficult access patients prior to cannulation attempts. Purpose: The purpose of this literature review was to examine A-DIVA score and the implementation of the use of ultrasound-guided peripheral intravenous access in the emergency department. Method: A systematic review of USGIV was completed of the following databases: OVID, Current Index to Nursing and Allied Health Literature (CINAHL), PubMed, EBSCO host, and Google Scholar. Conclusion: A gap existed in the use of USGPIV in the ED. Therefore, the application of an A-DIVA score to implement USGPIV access may be beneficial. The A-DIVA prediction tool may improve the success rate of peripheral vascular access in adults rated to have difficult vascular access. Research studies on this important topic are recommended.

P063: Ultrasound-guided peripheral intravenous access in the emergency department: a randomized controlled trial comparing single and dual-operator technique

Introduction: Ultrasound-guided intravenous (UGIV) insertion performed by nurses has been shown to be more effective than the blind approach for patients with difficult intravenous (IV) access in the emergency department (ED). While both the single-operator (SO) (where a single operator holds the IV and probe) and dual-operator (DO) (where a second operator holds the probe) techniques have been described, the DO is more resource-intensive, requiring a second operator to be present. The objective of this study is to compare the first-attempt cannulation success rates between a SO and DO technique in ED patients with predicted difficult access. Methods: We conducted a randomized controlled non-inferiority trial using a convenience sample of adult ED patients. Participating ED nurses received a one-hour UGIV training session including didactic and practical training on simulated arms. Patients were enrolled if they met any of three criteria for difficult access: (1) history of difficult access, (2) no visible or palpable veins, or (3) two failed blind attempts. Patients requiring active resuscitation, lack of suitable veins on US, or those unable to consent or comply with the procedure were excluded. Eligible patients were randomized to the SO or DO technique and a maximum of two UGIV attempts were allowed. The primary outcome was first-attempt success rate. Additional outcomes included overall success rate, number of attempts, time to successful cannulation, patient pain scores, operator ease of use scores, and complications 30 minutes after insertion. The chi-square test was used to compare success rates between groups and t-tests used for all other secondary outcomes. Results: 42 eligible patients have been approached for our study. 14 were excluded due to lack of visible veins on US or due to ongoing resuscitation. A total of 33 UGIV attempts were performed on 28 patients (17 in SO group, 16 in DO group). There was no statistically significant difference in first attempt success rates between the SO group of 76.5% (95% CI [50.1% to 93.2%]) and the DO group of 68.8% (95% CI [41.3% to 89%]) (p=0.62). There were also no statistically significant differences between the SO and DO groups in time to cannulation (140 vs 165 seconds, p=0.36), patient preference on a 10-point scale (7.0 vs 7.9, p=0.49), patient pain score (6.3 vs 6.6, p=0.87) or nursing ease of use (5.3 vs 6.5 p=0.23) respectively. There were no complications noted in either arm of the study. Conclusion: To date, the SO technique appears to be non-inferior to the DO technique for successful UGIV cannulation. Our results support the use of the SO technique, reducing the need for additional nursing resources when performing this procedure.

Validation of the Peripheral Ultrasound-guided Vascular Access Rating Scale.

Evidence-based standards in proficiency are needed for ultrasound-guided peripheral intravenous access. In this study, we explored the validity of the Peripheral Ultrasound-Guided Vascular Access (P-UGVA) Rating Scale.We recruited 3 groups of physicians (5 novices, 5 intermediates, and 5 experts) of increasing proficiency in peripheral ultrasound-guided intravenous access. All participants performed 3 peripheral ultrasound-guided intravenous accesses on three different patients. Performance was video-recorded by 3 cameras and the ultrasound image. Synchronized and anonymized split-screen film clips were rated using the P-UGVA rating scale by 2 assessors, which also assessed overall performance on a 1–5 Likert-scale. Evidence of validity was explored using the contemporary validity framework by Messick (content, response process, internal structure, relations to other variables, and consequences).Content and response process was ensured in the development of the rating scale and validity study. Internal consistency of the P-UGVA rating scale was excellent and sufficient high for certification purposes (Cronbach's alpha = 0.91). Proficiency groups were successfully discriminated by the UPGIVA rating scale (P = .029, one-way ANOVA), and the P-UGVA rating scale scores also correlated strongly with the overall performance evaluations (rho = 0.87, P < .001, Pearson correlation). We calculated a pass/fail score of 29, which lead to a theoretical false positive rate of 26.5% and false negative rate of 8.5%.We present validity evidence for the P-UGVA rating scale and an evidence-based standard in proficiency for ultrasound-guided peripheral intravenous access.

P020: Ultrasound-guided peripheral intravenous access in the emergency department: A randomized controlled trial comparing single and dual-operator technique

Introduction: Intravenous (IV) cannulation is a common and important procedure in the emergency department (ED). Ultrasound-guided IV (UGIV) insertion has been shown to be more effective than the blind approach for patients with difficult IV access. The optimal technique for UGIV insertion has not been determined. The objective of this study is to compare the first-attempt canulation success rate between a single-operator technique (provider holds the ultrasound probe while simultaneously placing the IV), with dual-operator technique (whereby a second provider holds the probe) in ED patients with predicted difficult access. Methods: We conducted a randomized controlled trial using a convenience sample of adult ED patients. Participating ED nurses received a one-hour UGIV training session on including didactic and practical training on simulated arms. Patients were enrolled if they met any of three criteria for difficult access: (1) history of difficult access, (2) no visible or palpable veins, or (3) two failed blind attempts. High-acuity patients or those unable to consent or comply with the procedure were excluded. Eligible patients were randomized to single or dual-operator technique and a maximum of two UGIV attempts were allowed. The primary outcome was first-attempt success rate. Additional outcomes included overall success rate, number of attempts, time to successful cannulation (needle insertion to flashback), patient pain scores, operator ‘ease of use’ scores, and complications 30 minutes after insertion including IV failure. Other variables collected included patient demographics, presenting complaint, indication for ultrasound use, relevant medical history, and location/depth of the target vessel. Fisher’s exact test was used to compare success rates between groups. Results: Data collection was ongoing at the time of submission, but is expected to be completed by May 01, 2017. Conclusion: This is the first randomized-controlled trial comparing single and dual-operator ultrasound technique for difficult IV insertion in ED patients. The results from this study will provide evidence to guide education, and ensure best practice of UGIV insertion in the ED.

A randomized study of training with large versus small vessel size on successful ultrasound-guided peripheral venous access

Our objective was to investigate whether training on phantoms with smaller or larger vessels would improve success rate in novice medical students learning this skill. Medical students who participated in a voluntary, extracurricular ultrasound training day were asked to participate in the study as part of their procedural training. They were given a standardized education and demonstration of how to use ultrasound to place a peripheral intravenous (IV) catheter. They were then randomized to practice three times on homemade phantom models with either a 5-mm or a 2.5-mm diameter simulated vessel. Afterwards, they were observed attempting to place an ultrasound-guided IV on a 5-mm diameter vessel. Successful cannulation rates was the primary outcome. Fifty-one students from five institutions were included in the analysis. No significant difference in success rate, time to cannulation, number of sticks, or number of redirects was seen between the group who trained on the phantoms with the smaller vessels versus those who trained on the phantoms with the larger vessel. A trend towards significance was seen for success rate and number of redirects, favoring the group trained on the smaller vessels, but this did not reach significance. In our small sample, there was no difference in success rate of novice students trained in ultrasound-guided peripheral IV access using either a smaller or a larger vessel phantom. Future work should focus on elucidating other aspects of training in ultrasound-guided procedures and should attempt a similar study with a larger sample size.

Efficacy of Ultrasound-Guided Peripheral Intravenous Access: A Systematic Review and Meta-Analysis

Peripheral intravenous access is a common, invasive procedure that is performed in clinical practice. Difficult intravenous access may not only jeopardize patient safety but also increase staff stress, nursing hours, and material costs. To explore the efficacy of ultrasound-guided peripheral intravenous access in difficult intravenous-access patients and in the two subgroups of adult patients and pediatric patients using systematic review and meta-analysis. Six Chinese and English databases, including the Index to Taiwan Periodical Literature System, Airiti Library, CINAHL, Cochrane Library, PubMed/MEDLINE, and ProQuest, were searched for related articles that were published between the earliest year available and April 2016. The search was limited to studies that used randomized control trials (RCTs) or controlled clinical trials (CCTs) and the associated key words "ultrasound-guided" AND "peripheral intravenous access". The 12 articles that met these criteria were used in the analysis. The Joanna Briggs Institute (JBI) critical appraisal checklist was used to assess methodological quality and RevMan 5.3 software was used to conduct the meta-analysis. The ultrasound-guided technique was found to improve the success rate of intravenous access significantly (OR = 3.00, p < .0001) and to decrease the number of attempts (MD = -0.61, p = .03) in the overall group of difficult intravenous-access patients. The subgroup analysis found a significantly improved success rate and decreased number of attempts in difficult intravenous-access adult patients and significantly decreased procedural times in difficult intravenous-access pediatric patients. The ultrasound-guided technique may improve the efficacy of intravenous access by helping health care professionals visualize the peripheral veins. We suggest that patient characteristics, ultrasound accessibility, and the feasibility of staff training be assessed in order to provide ultrasound guidance that improves the efficacy of intravenous access.

An Assessment Tool for the Placement of Ultrasound-Guided Peripheral Intravenous Access.

Background Ultrasound-guided peripheral intravenous line (USGPIV) placement is becoming an important tool in current clinical practice. Many residency programs utilize unstructured clinical observation to evaluate residents in this and other procedural skills. Simulation-based assessment permits educators to make objective, standardized observations, and may be ideal for assessment of important procedural competencies. Objective We created a simulation-based assessment tool for the skill of USGPIV placement. Methods A checklist tool was developed by a review of relevant literature and an expert review in accordance with established guidelines. Emergency medicine residents were recruited and surveyed on previous experience with USGPIV placement. Blinded, independent reviewers then utilized the checklist to assess residents as they made up to 3 attempts at USGPIV placement on a simulated pediatric arm. Results Of the 26 residents enrolled in our study, 26 participated (100%). A best attempt checklist score greater than or equal to 9 out of 10 correlated with expert performance (P < .001). Agreement between independent raters on first-attempt USGPIV placement score was determined by weighted kappa statistics to be 0.93 (95% CI 086-1.00). Conclusions The checklist assessment tool has acceptable interrater reliability and ability to distinguish performance at differing levels of competence. We propose this tool as a valuable component in the assessment of USGPIV access, and we hope this article serves as a roadmap for other educators to create similar assessment tools.

Ultrasound-Guided Peripheral Intravenous Access Program for Emergency Physicians, Nurses, and Corpsmen (Technicians) at a Military Hospital.

Peripheral intravenous (PIV) access is a common procedure in the emergency department (ED). However, conditions such as obesity and hypovolemia can often make access difficult by the traditional landmark technique. The use of ultrasonography has improved the success of PIV placement in this setting. A novel Ultrasound (US)-Guided PIV Access program was initiated in our ED to train emergency nurses, U.S. Navy corpsmen, and physicians. This was an observational study of emergency providers performing US-guided PIV placement. After a training session, all ED providers began utilizing the US for difficult intravenous access patients. All complications, location of access, and previous experience level were recorded. The choice of a transverse, longitudinal, or a combination approach was also recorded. We did not observe significant differences in ability with US-guided PIV access when comparing success rates between emergency physicians, nurses, and technicians (p = 0.13). In the novice user, a transverse or a novel combination of a transverse and longitudinal method appears to be the most successful. ED physicians, nurses, and corpsmen can successfully place US-guided peripheral catheters for venous access. Developing a training program for emergency providers in US-guided venous cannulation is feasible and safe.

Ultrasound-Guided Peripheral IV Access in the Hands of Nurses' Aides

Multiple small studies since 2005 have shown that ultrasound guidance improves success of peripheral intravenous (IV) line placement when access is

A Review of Pediatric Ultrasound-Guided Peripheral Intravenous Access

Point-of-care ultrasound is at an early developmental stage in the field of pediatric emergency medicine. Ultrasound-guided vascular access has been identified as a key procedural application by several published educational guidelines and surveys of pediatric emergency medicine directors, fellowship directors, and fellows, and ultrasound-guided peripheral vascular access is well suited for the pediatric population. This article reviews the current literature on pediatric ultrasound-guided peripheral vascular access methods and demonstrates the suitability of point-of-care ultrasound as a safe, effective, patient-centered, timely, efficient, and equitable means of establishing peripheral vascular access in pediatric patients.

151 Ultrasound-Guided Peripheral Intravenous Access by Emergency Department Technicians is a Safe and Effective Strategy for Avoiding Unnecessary Central Venous Catheters

151 Ultrasound-Guided Peripheral Intravenous Access by Emergency Department Technicians is a Safe and Effective Strategy for Avoiding Unnecessary Central Venous Catheters

Randomized trial of tourniquet vs blood pressure cuff for target vein dilation in ultrasound-guided peripheral intravenous access

BackgroundTen percent of the time, peripheral intravenous access (PIV) is not obtained in 2 attempts in the emergency department. Typically, a tourniquet is used to dilate the target vein; but recent research showed that a blood pressure (BP) cuff improves dilation, which may translate to increased PIV success. ObjectivesWe sought to determine if there is improved success in obtaining ultrasound-guided PIV using a BP cuff vs a tourniquet in “difficult stick” patients. MethodsThis is a prospective, randomized, single-blinded trial. Adult patients requiring PIV with at least 2 prior failed attempts were enrolled. Patients were assigned to tourniquet or BP cuff for target vein dilation randomly. Nurses prepared the patient for PIV attempt by either placing a BP cuff inflated to 150 mm Hg or placing a tourniquet on the chosen extremity. The extremity was draped to blind the physician to assignment. Physicians then attempted ultrasound-guided PIV. Failures were defined as IVs requiring greater than 3 ultrasound-guided attempts or 30 minutes, or patient intolerance. If failure occurred, the physician was unblinded; and the patient could be crossed over and reattempted. ResultsThirty-eight patients were enrolled. The success rate for the tourniquet group (n = 17) and BP cuff group (n = 21) was 82.4% and 47.6%, respectively (P = .04). There were no differences between groups for vessel depth, diameter, or procedure time. Six in the BP cuff group were crossed over and had successful PIV obtained with tourniquet. ConclusionsTourniquet is superior to BP cuff for target vein dilation in ultrasound-guided PIV.

Ultrasound-Guided Peripheral Intravenous Access Program Is Associated With a Marked Reduction in Central Venous Catheter Use in Noncritically Ill Emergency Department Patients

We examine the central venous catheter placement rate during the implementation of an ultrasound-guided peripheral intravenous access program. We conducted a time-series analysis of the monthly central venous catheter rate among adult emergency department (ED) patients in an academic urban ED between 2006 and 2011. During this period, emergency medicine residents and ED technicians were trained in ultrasound-guided peripheral intravenous access. We calculated the monthly central venous catheter placement rate overall and compared the central venous catheter reduction rate associated with the ultrasound-guided peripheral intravenous access program between noncritically ill patients and patients admitted to critical care. Patients receiving central venous catheters were classified as noncritically ill if admitted to telemetry or medical/surgical floor or discharged home from the ED. During the study period, the ED treated a total of 401,532 patients, of whom 1,583 (0.39%) received a central venous catheter. The central venous catheter rate decreased by 80% between 2006 (0.81%) and 2011 (0.16%). The decrease in the rate was significantly greater among noncritically ill patients (mean for telemetry patients 4.4% per month [95% confidence interval {CI} 3.6% to 5.1%], floor patients 4.8% [95% CI 4.2% to 5.3%], and discharged patients 7.6% [95% CI 6.2% to 9.1%]) than critically ill patients (0.9%; 95% CI 0.6% to 1.2%). The proportion of central venous catheters that were placed in critically ill patients increased from 34% in 2006 to 81% in 2011 because fewer central venous catheterizations were performed in noncritically ill patients. The ultrasound-guided peripheral intravenous access program was associated with reductions in central venous catheter placement, particularly in noncritically ill patients. Further research is needed to determine the extent to which such access can replace central venous catheter placement in ED patients with difficult vascular access.