Effectiveness of ultrasonography for peripheral catheter insertion and catheter failure prevention in visible and palpable veins

Abstract

Background: The increase in the success rate of peripheral intravenous catheterization against a difficult intravenous access (DIVA) using ultrasonography is reported; however, reports related to the effectiveness of using ultrasonography in increasing the success rate for visible and palpable veins is limited. Furthermore, according to a previous study, first attempt success in catheterization contributes to low catheter failure incidence. Thus, we developed a catheterization method using ultrasonography for peripheral veins including visible and palpable veins. This study investigates the effectiveness of ultrasonography use in improving the success rate of catheterization and preventing the catheter failure for peripheral veins including visible and palpable veins. Methods: Adult inpatients were recruited. Trained nurses inserted intravenous catheters using ultrasonography. Ultrasonography was used for all vein assessment, target vein selection, and puncturing (i.e. target point selection and/or needle guidance), regardless of the target vein’s visibility or palpability. Catheters with over a 24-h dwelling time were followed for catheter failure incidence. Results: Thirty-one patients were recruited, and they required 34 catheterizations. Total number of catheterization attempts were 39. Of the peripheral veins, 51.3% (20/39) were visible and palpable, 48.7% (19/39) were DIVA. The rate of successful intravenous cannulation was 29 of 34 (85.3%) after one attempt and 4 of 34 (total 97.0%) after two attempts. The catheterization failure incidence was 3.2% (1/31) in the catheter that had an over 24-h dwelling time. Conclusions: Using ultrasonography to all target veins might have contributed to higher success rates of catheterization and extremely low incidence of catheter failure based on objective findings. Selecting the vein with larger diameters and healthy tissue as puncture point and showing center of vessel lumen clearly using ultrasonography might have been contributed the results.

An Improved Definition and SAFE Rule for Predicting Difficult Intravascular Access (DIVA) in Hospitalized Adults

“…Other definitions considered a history of DIVA (n = 1), the need for a rescue technique (n = 2), abandonment of the procedure (n = 1), no visible or palpable veins after placing a tourniquet (n = 1), procedure duration of more than 1 minute (n = 1), use of central venous access (n = 1), and failure after 2 or more (n = 1) or 3 or more (n = 2) insertion attempts (Table 1). [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] The literature review identified DIVA risk factors for a total of 15 628 patients, but the heterogeneity of collected risk factors was a constraint on the sample size available for each of the factors in the current analysis.…”

Handheld Ultrasound Devices for Peripheral Intravenous Cannulation

“…Eight studies were conducted in the United States, [21][22][23][24][25][26][27][28] 3 studies in Japan, [29][30][31] 2 in Australia, 10,32 and 1 study each in the Czech Republic, 33 Denmark, 34 Italy, 35 and the Netherlands. 36 Study designs included 9 prospective observational cohort studies, 10,[24][25][26]28,29,31,32,36 2 randomized trials, 23,33 3 prospective pre-post studies, 27,30,34 and 3 retrospective chart audits. 21,22,35 Most were conducted in single inpatient facilities (82%); 1 was a multicenter study, 36 and 2 studies reported ultrasound outcomes in prehospital settings.…”

“…21,22,35 Most were conducted in single inpatient facilities (82%); 1 was a multicenter study, 36 and 2 studies reported ultrasound outcomes in prehospital settings. 10,33 Settings included emergency department, [21][22][23][24][25]28,35 ward settings, [29][30][31] telemetry, 26 operating suite and radiology, 36 and mixed settings. 27,32,34 Adults were the focus patient population in 15 studies, with pediatrics included in 3 studies.…”

“…22,23,27,30,33,34 Dynamic ultrasound technique (real-time visualization during vessel cannulation) was used in 15 of 17 studies. 10,21,22,[24][25][26][27][29][30][31][32][33][34][35][36] Static ultrasound technique (visualization of vessels prior to cannulation and marking of the skin insertion point), followed by standard insertion technique, featured in 3 studies. 23,29,33 One study that compared dynamic and static techniques reported more favorable insertion outcomes (first-attempt success, number of attempts per patient, time to insertion) when the static method was used.…”

“…10,21,22,[24][25][26][27][29][30][31][32][33][34][35][36] Static ultrasound technique (visualization of vessels prior to cannulation and marking of the skin insertion point), followed by standard insertion technique, featured in 3 studies. 23,29,33 One study that compared dynamic and static techniques reported more favorable insertion outcomes (first-attempt success, number of attempts per patient, time to insertion) when the static method was used. 33 In another study, doctors used ultrasound static technique to mark the site for the nurses to cannulate.…”