Effect of two tourniquet techniques on peripheral intravenous cannulation success: A randomized controlled trial

Tran, Theresa; Lund, Sarah; Nichols, Micah D.; Kummer, Tobias

doi:10.1016/j.ajem.2019.03.034

Cited by 10 publications

(11 citation statements)

References 16 publications

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“…Failed first attempts of peripheral intravenous cannulation may negatively affect patients by causing anxiety, unnecessary pain, a delay in therapy, and loss of potential venous access sites. 25,26 Moreover, increasing first attempt success rates may potentially improve patient satisfaction, turnover and throughput in the hospital, and outcomes related to various time-sensitive diseases. 25 Due to the high prevalence of the procedure of peripheral intravenous cannulation and the relatively high incidence of failure on the first attempt, was this subject of many recently performed studies.…”

Section: Discussionmentioning

confidence: 99%

“…25,26 Moreover, increasing first attempt success rates may potentially improve patient satisfaction, turnover and throughput in the hospital, and outcomes related to various time-sensitive diseases. 25 Due to the high prevalence of the procedure of peripheral intravenous cannulation and the relatively high incidence of failure on the first attempt, was this subject of many recently performed studies. 27 Most of these studies considered few aspects simultaneously and focused mostly on patient- or practitioner-related factors, without covering device-related factors.…”

Section: Discussionmentioning

confidence: 99%

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The impact of a notched peripheral intravenous catheter on the first attempt success rate in hospitalized adults: Block-randomized trial

et al. 2021

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Introduction: Peripheral intravenous cannulation is the preferred method to obtain vascular access, but not always successful on the first attempt. Evidence on the impact of the intravenous catheter itself on the success rate is lacking. Faster visualization of blood flashback into the catheter, as a result of a notched needle, is thought to increase first attempt success rate. The current study aimed to assess if inserting a notched peripheral intravenous catheter will increase first attempt cannulation success up to 90%, when compared to inserting a catheter without a notched needle. Design: In this block-randomized trial, adult patients in the intervention group got a notched peripheral intravenous catheter inserted, patients in the control group received a traditional non-notched catheter. The primary objective was the first attempt success rate of peripheral intravenous cannulation. Intravenous cannulation was performed according to practice guidelines and hospital policy. Results: About 328 patients were included in the intervention group and 330 patients in the control group. First attempt success was 85% and 79% for the intervention and control group respectively. First attempt success was remarkably higher in the intervention group regarding patients with a high risk for failed cannulation (29%), when compared to the control group (10%). Conclusion: This study was unable to reach a first attempt success of 90%, although first attempt cannulation success was higher in patients who got a notched needle inserted when compared to those who got a non-notched needle inserted, unless a patients individual risk profile for a difficult intravenous access.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The impact of a notched peripheral intravenous catheter on the first attempt success rate in hospitalized adults: Block-randomized trial

et al. 2021

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“…Actually, in clinic, both ET and BPC perform similar venodilation for successful peripheral intravenous cannulation [20]. Nevertheless, this was not paradoxical with above results, BPC with 60mmHg and 90mmHg inflation pressure did increase the vein size significantly, just because the difference between ET and BPC was too small to be clinically significant.…”

Section: Discussionmentioning

confidence: 68%

“…Actually, many factors affect success rate of first IVA. For instance, previous history of a difficult IVA, clinicians' great confidence and experience, IVA site, and so on [20,[24][25]. However, the palpability and diameter of peripheral vein might be more important than others [3,[24][25].…”

Section: Discussionmentioning

confidence: 99%

Which, Tourniquet or Inflation of Blood Pressure Cuff, can Dilate Peripheral Vein Adequately for Intravenous Access?

Xiong¹,

Zhan²,

Ding³

et al. 2019

BJSTR

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Objectives: Peripheral intravenous access is a common clinical procedure. It is wellknown that venodilation improves success rate of peripheral intravenous cannulation. Elastic tourniquet and blood pressure cuff are frequently applied to dilate peripheral veins. The objective of this study is to evaluate which maneuvers designed to dilate antecubital veins are more effective. Methods:This was a prospective non-random trail enrolling fifty healthy volunteers. Ultrasound was used to select an antecubital vein as a target vein. Its' diameter and cross-section area were measured sonograghically at the same position with different maneuvers, that was baseline, elastic tourniquet and blood pressure cuff with different inflation pressure. The blood pressure cuff was inflated with pressure from 30mmHg to 120mmHg, in 30mmHg increments. Time-intervals between each maneuver were longer enough and basic measurements were repeated to ensure the target vein recover to initial state. At the same time, volunteers' subjective feeling and degrees of tight under different maneuvers were recorded and evaluated by Visual Analogue Scale. Comparisons among different maneuvers were performed by Repeated Measurement test and Bonferroni test. Non-parametric test Kruskal-Wallis One-Way ANOVA was used to pairwise compare differences of volunteers' scores of Visual Analogue Scale. The differences of diameter and cross-section area between right and left arm were evaluated by Paired-Sample test.Results: All maneuvers dilated diameters and cross-section areas of target antecubital veins significantly from baseline (P=0.000). Target veins were dilated most significantly by blood pressure cuff with 60mmHg inflation pressure (P=0.000). Blood pressure cuff with 90mmHg inflation pressure resulted in the second largest increase in target vein size (P=0.000). Although there were no significant differences between blood pressure cuff with inflation of 30mmHg and 120mmHg pressure (P=1.000), elastic tourniquet significantly increases diameters and cross-section areas of target vein size when compared to them (P=0.000). Scores of Visual Analogue Scale of elastic tourniquet and blood pressure cuff with 120mmHg inflation pressure were not significantly different (P=0.581), but these were significantly higher than other maneuvers (P=0.000).Blood pressure cuff with 30mmHg inflation pressure significantly decreased the score of Visual Analogue Scale, when compared with maneuvers of 60mmHg and 90mmHg inflation pressure. Nevertheless, there was no significant difference between the scores of 60mmHg and 90mmHg inflation pressure (P=0.369). The differences of baseline of

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“…[34] 1) Sphygmomanometer cuff S o m e p h y s i c i a n s a d v o c a t e i n f l a t i n g a sphygmomanometer cuff to around diastolic blood pressure instead of using the traditional tourniquet to improve patient comfort and avoid traumatizing fragile veins. [35] Kule et al [36] reported that using a sphygmomanometer cuff decreased vein compressibility significantly and proved superior to tourniquets, but this was disputed by Nelson et al [37] and Tran et al [38] These contradictions were explained by Sasaki who proposed that vein size paradoxically decreased once pressures exceeded 100 mmHg (1 mmHg=0.133 kPa), [39] presumably due to occluded arterial inflow. Sasaki's theory is supported by Xiong et al [40] who demonstrated that 60-90 mmHg is the optimal inflation pressures.…”

Section: Tourniquet Applicationmentioning

confidence: 99%

Management of difficult intravenous access: a qualitative review

Ng¹,

Mark²,

Lateef³

2022

World Journal of Emergency Medicine

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Establishing peripheral intravenous access (PIV) is one of the most ubiquitous and crucial steps in managing critically ill patients. Yet only 74% of first attempts during emergency resuscitation in adults [1] are successful and this falls to an even-more-dismal 33% in difficult intravenous access (DIVA) patients. [2] A perennial challenge faced by clinicians, DIVA impacts patient outcomes adversely by causing downstream delays in both diagnoses (difficulty in obtaining blood specimens and administering intravenous contrast for advanced imaging) and therapy (provision of parenteral fluids, blood products or drug administration to facilitate procedures such as sedation or rapid-sequence intubation). [3] Failed cannulation attempts often cause patient and clinician alike considerable frustration and distress and may lead to complications like thrombophlebitis, infection and haematoma. [4] Moreover, time-to-cannulation averages 2.5-13.0 min for most patients but can take up to 30 min to hours in DIVA cases. [5] As DIVA patients tend to distract disproportionately more time and attention of the attending emergency physicians, this inevitably compromises the care of other patients.Although there is no consensus or universallyaccepted definition, DIVA is commonly defined as either two or more failed attempts by an experienced operator using traditional landmark-based methods BAcKGRound: A perennial challenge faced by clinicians and made even more relevant with the global obesity epidemic, difficult intravenous access (DIVA) adversely impacts patient outcomes by causing significant downstream delays with many aspects of diagnoses and therapy. As most published DIVA strategies are limited to various point-of-care ultrasound techniques while other "tricks-of-the-trade" and pearls for overcoming DIVA are mostly relegated to informal nonpublished material, this article seeks to provide a narrative qualitative review of the iterature on DIVA and consolidate these strategies into a practical algorithm. MEtHodS:We conducted a literature search on PubMed using the keywords "difficult intravenous access", "peripheral vascular access" and "peripheral venous access" and searched emergency medicine and anaesthesiology resources for relevant material. These strategies were then categorized and incorporated into a DIVA algorithm. RESuLtS:We propose a Vortex approach to DIVA that is modelled after the Difficult Airway Vortex concept: starting off with standard peripheral intravenous cannulation (PIVC) techniques, progressing sequentially on to ultrasound-guided cannulation and central venous cannulation and finally escalating to the most invasive intraosseous access should the patient be in extremis or should best efforts with the other lifelines fail. concLuSIon: DIVA is a perennial problem that healthcare providers across various disciplines will be increasingly challenged with. It is crucial to have a systematic stepwise approach such as the DIVA Vortex when managing such patients and have at hand a wide repertoire of techniques t...

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Effect of two tourniquet techniques on peripheral intravenous cannulation success: A randomized controlled trial

Cited by 10 publications

References 16 publications

The impact of a notched peripheral intravenous catheter on the first attempt success rate in hospitalized adults: Block-randomized trial

The impact of a notched peripheral intravenous catheter on the first attempt success rate in hospitalized adults: Block-randomized trial

Which, Tourniquet or Inflation of Blood Pressure Cuff, can Dilate Peripheral Vein Adequately for Intravenous Access?

Management of difficult intravenous access: a qualitative review

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