Comparison of Standard Technique, Ultrasonography, and Near-Infrared Light in Difficult Peripheral Vascular Access: A Randomized Controlled Trial

Abstract

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 compared standard technique, ultrasonography (USG), and near-infrared light (NIR) in terms of success in the first attempt in patients with DVA. Methods: 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. Results: 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. Conclusion: It was found that USG increases the success of the first attempt compared with the standard method and NIR in patients with DVA.

The Utilization of Handheld Ultrasound Devices in a Prehospital Setting

“…7,18 This study did not include patients with cardiac arrest. This may be due to the fact that complicated interventions 23 are usually performed to take care of these patients during the transport; hence, physicians could not have enough time to perform POCUS. However, previous studies [24][25][26] demonstrated the feasibility and the utility of POCUS in out-of-hospital cardiac arrest patients, which showed the advantage of POCUS used.…”

Automatic vein measurement by ultrasonography to prevent peripheral intravenous catheter failure for clinical practice using artificial intelligence: development and evaluation study of an automatic detection method based on deep learning

“…Catheter failure is a widespread problem 4. Although financial costs need to be considered, there is already evidence of the preventive effect of US17 18 and it is expected to be effective in many clinical settings.…”

“…The algorithm was designed with the procedures used and conditional branches dependent on the patient’s vascular situation. However, compliance was low at 16.1% (23 of 143), which could be due to the low visibility of US images and the specialised training required for assessment of blood vessels on US images 18 19…”

“…However, compliance was low at 16.1% (23 of 143), which could be due to the low visibility of US images and the specialised training required for assessment of blood vessels on US images. 18 19 …”

Ultrasound-guided versus traditional method for peripheral venous access: an umbrella review

“…Regarding efficiency, no studies found a significant positive effect of US versus traditional method in the time spent in SPC insertion, as stated by a recent RCT which has not been included in any systematic review [ 34 ]. The lack of significant findings may result from the large variability among studies.…”