Preventing the Collapse of a Peripheral Vein During Cannulation: An Evaluation of Various Tourniquet Techniques on Vein Compressibility

Kule, Amy; Hang, B.; Bahl, Amit

doi:10.1016/j.jemermed.2013.08.088

Cited by 17 publications

(14 citation statements)

References 8 publications

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“…Before cannulation, a tourniquet was placed on the upper extremity, at least 10 cm proximal to the elbow crease, to apply dilatation of the target vein. 17 , 18 The tourniquet was tightened while maintaining pulsations of the radial artery. The skin was cleaned with chlorhexidine 70%.…”

Section: Methodsmentioning

confidence: 99%

Development of the A-DIVA Scale

et al. 2016

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Placement of a peripheral intravenous catheter is a routine procedure in clinical practice, but failure of intravenous cannulation regularly occurs. An accurate and reliable predictive scale for difficult venous access creates the possibility to use other techniques in an earlier time frame.We aimed to develop a predictive scale to identify adult patients with a difficult intravenous access prospectively: the A-DIVA scale.This prospective, observational, cross-sectional cohort study was conducted between January 2014 and January 2015, and performed at the department of anesthesiology of the Catharina Hospital (Eindhoven, The Netherlands). Patients 18 years or older were eligible if scheduled for any surgical procedure, regardless ASA classification, demographics, and medical history.Experienced and certified anesthesiologists and nurse anesthetists routinely obtained peripheral intravenous access. Cannulation was performed regarding standards for care.A failed peripheral intravenous cannulation on the first attempt was the outcome of interest.A population-based sample of 1063 patients was included. Failure of intravenous cannulation was observed in 182/1063 patients (17%). Five variables were associated with a failed first attempt of peripheral intravenous cannulation: palpability of the target vein (OR = 4.94, 95% CI [2.85–8.56]; P < 0.001), visibility of the target vein (OR = 3.63, 95% CI [2.09–6.32]; P < 0.001), a history of difficult peripheral intravenous cannulation (OR = 3.86, 95% CI [2.39–6.25]; P < 0.001), an unplanned indication for surgery (OR = 4.86, 95% CI [2.92–8.07]; P < 0.001), and the vein diameter of at most 2 millimeters (OR = 3.37, 95% CI [2.12–5.36]; P < 0.001). The scoring system was applied in 3 risk groups: 36/788 patients (5%) suffered from a failed first attempt in the low-risk group (A-DIVA score 0 or 1), whereas the medium (A-DIVA score 2 or 3) and high-risk group (A-DIVA score 4 plus), included 72/195 (37%) and 74/80 (93%) patients with a failed first attempt of inserting a peripheral intravenous catheter, respectively.The additive 5-variable A-DIVA scale is a reliable predictive rule that implies the probability to identify patients with a difficult intravenous access prospectively.Dutch Trial Register (ref: 4595).

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Section: Methodsmentioning

confidence: 99%

Development of the A-DIVA Scale

et al. 2016

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“…Sometimes the addition of a second tourniquet or a blood pressure cuff inflated to 150 mm Hg may be needed to ensure sufficient venous distension. 31 …”

Section: Preparationmentioning

confidence: 99%

Ultrasound-Guided Peripheral Intravenous Line Placement: A Narrative Review of Evidence-based Best Practices

Gottlieb¹,

Sundaram²,

Holladay³

et al. 2017

WestJEM

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Peripheral intravenous line placement is a common procedure in emergency medicine. Ultrasound guidance has been demonstrated to improve success rates, as well as decrease complications and pain. This paper provides a narrative review of the literature focusing on best practices and techniques to improve performance with this procedure. We provide an evidence-based discussion of preparation for the procedure, vein and catheter selection, multiple techniques for placement, and line confirmation.

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“…There were several limitations to our investigation. We did not account for compressibility of the vein in this trial, the key difference observed between double and single tourniquet in previous comparisons of the techniques 12. Although we measured vein dilation in both groups, it is possible that compressibility may impact successful cannulation independent of vein size.…”

Section: Limitationsmentioning

confidence: 99%

“…In a previous comparison of ST vs DT, tourniquet placement was standardized and specific vessels in the arm were measured 12. In our study, the selection of vessel and subsequent tourniquet placement was left to the discretion of the inserters in anticipation of variation of vein depth and accessibility across our patient population.…”

Section: Limitationsmentioning

confidence: 99%

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Single Versus Double Tourniquet Technique for Ultrasound-Guided Venous Catheter Placement

Price

Xiao

Tausch

et al. 2019

WestJEM

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IntroductionPeripheral, ultrasound-guided intravenous (IV) access occurs frequently in the emergency department, but certain populations present unique challenges for successfully completing this procedure. Prior research has demonstrated decreased compressibility under double tourniquet technique (DT) compared with single tourniquet (ST). We hypothesized that catheters inserted under DT method would have a higher first-stick success rate compared with those inserted under ST method.MethodsWe randomized 100 patients with a history of difficult IV access, as defined by past ultrasound IV, prior emergency visit with two or more attempts required for vascular access, history of IV drug abuse, history of end stage renal disease on hemodialysis or obesity, to ultrasound-guided IV placement under either DT or ST method. We measured the vein characteristics measured under ultrasound, and recorded the number of attempts and location of attempts at vascular access.ResultsOf an initial 100 patients enrolled, we analyzed a total of 99 with 48 placed under ST and 51 placed under DT. Attending physicians inserted 41.7% of ST and 41.2% of DT, with non-attending inserters (including residents, nurses, and technicians) inserted the remainder. First-stick success rate was observed at 64.3% in ST and 66.7% in DT (p=0.93). Attendings had an overall higher first-stick success rate (95.1%) compared to non-attending inserters (65.5%) (p=<0.001). The average vein depth measured in ST was 0.73 centimeters (cm) compared with 0.87 cm in DT (p=0.02).ConclusionDT technique did not produce a measureable increase in first-stick success rate compared to ST, including after adjusting for level of training of inserter. However, a significant difference in average vein depth between the study arms may have limited the reliability of our overall results. Future studies controlling for this variable may be required to more accurately compare these two techniques.

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Preventing the Collapse of a Peripheral Vein During Cannulation: An Evaluation of Various Tourniquet Techniques on Vein Compressibility

Cited by 17 publications

References 8 publications

Development of the A-DIVA Scale

Development of the A-DIVA Scale

Ultrasound-Guided Peripheral Intravenous Line Placement: A Narrative Review of Evidence-based Best Practices

Single Versus Double Tourniquet Technique for Ultrasound-Guided Venous Catheter Placement

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