What You See (Sonographically) Is What You Get: Vein and Patient Characteristics Associated With Successful Ultrasound‐guided Peripheral Intravenous Placement in Patients With Difficult Access

Abstract

Objectives: Ultrasound (US) has been shown to facilitate peripheral intravenous (IV) placement in emergency department (ED) patients with difficult IV access (DIVA). This study sought to define patient and vein characteristics that affect successful US-guided peripheral IV placement.Methods: This was a prospective observational study of US-guided IV placement in a convenience sample of DIVA patients in an urban, tertiary care ED. DIVA patients were defined as having any of the following: at least two failed IV attempts or a history of difficult access plus the inability to visualize or palpate any veins on physical exam. Patient characteristics (demographic information, vital signs, and medical history) were collected on enrolled patients. The relationships between patient characteristics, vein depth and diameter, US probe orientation, and successful IV placement were analyzed.Results: A total of 169 patients were enrolled, with 236 attempts at access. Increasing vessel diameter was associated with a higher likelihood of success (odds ratio [OR] = 1.79 per 0.1-cm increase in vessel diameter, 95% confidence interval [CI] = 1.37 to 2.34). Increasing vessel depth did not affect success rates (OR = 0.96 per 0.1-cm increase of depth, 95% CI = 0.89 to 1.04) until a threshold depth of 1.6 cm, beyond which no vessels were successfully cannulated. Probe orientation and patient characteristics were unrelated to success.Conclusions: Success was solely related to vessel characteristics detected with US and not influenced by patient characteristics or probe orientation. Successful DIVA was primarily associated with larger vessel, while vessel depth up to >1.6 cm and patient characteristics were unrelated to success. Clinically, if two vessels are identified at a depth of <1.6 cm, the larger diameter vessel, even if comparatively deeper, should yield the greatest likelihood of success.

The effect of vessel depth, diameter, and location on ultrasound-guided peripheral intravenous catheter longevity

“…11,13 The current study shows that after successful cannulation the continued survival of the IV is also influenced by depth, and, in addition, by IV location. Vessel diameter did not affect catheter survival after successful placement.…”

“…The original analysis of this USGPIV database examined the relation between vessel depth and diameter on success of USGPIV placement and has been reported in the literature. 11 For the current study an additional retrospective chart review was performed on patients in the database to determine the outcome and survival time of the USGPIVs. The institution internal review board approved the study and written informed consent was obtained for all patients.…”

Inovação tecnológica para punção venosa periférica: capacitação para uso da ultrassonografia

“…Aiming at the adoption of safe practices to infusion therapy, authors recommend that nurses who perform the puncture use the puncture procedure that is more familiar to them. Thus, before the difficult venous access, inexperienced operators should attempt traditional puncture procedure, the jugular vein puncture, or consider the need of a central venous access, avoiding multiple attempts of ultrasound-guided puncture (21,28) .…”

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

“…The resultant 12 articles were reviewed for comments on technique in the skill of USGPIV placement. [3][4][5][10][11][12][13][14][15][16][17][18] Although the literature search yielded information on the benefits of USGPIV placement in pediatrics patients, the articles contained limited information on the procedural steps for placement of the line. Relevant sections of Roberts & Hedges' Clinical Procedures in Emergency Medicine were reviewed to develop a list of essential tasks for this procedure.…”

“…Baseline information about previous experience with USGPIV placement in pediatrics and adult patients and level of training was collected via a survey instrument (provided as online supplemental material). Resident participants were divided into 3 skill levels based on their report of previous experience with the following definitions: novice (0-5 USGPIV), intermediate (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and expert (. 20 USGPIV).…”