Ultrasound-guidance vs. standard technique in difficult vascular access patients by ED technicians

Purpose: We evaluated the efficacy and safety of emergency department technicians' (EDT) use of ultrasound (US) guided peripheral intravenous (PIV) access compared to the traditional approach on a subset of patients with difficult IV access. Methods: We enrolled a convenience sample of 75 ED patients with difficult IV access (at least 2 failed PIV attempts). During phase I, EDTs used the standard technique. EDTs then attended a didactic session on ultrasound guided PIV access of the tipper extremity. In phase II, the EDTs used US guidance for PIV access. Outcome measures were successful PIN cannulation by an EDT, time to cannulation, medical doctor (MD) or registered nurseRN intervention, complications, patient satisfaction, and number of skin punctures. Results: Successful cannulation rates were similar (US: 33/41, 80.5%; traditional technique: 24/34, 70.6%) (difference: 9.9%; 95% confidence interval (CI): -9.3%, 29.1%). US was 2.0 times faster (CI 1.3, 3.1), required less MD/RN intervention (7.3% vs. 20.6%) (difference: 13.3%; CI: -2.5, 30.2%), had fewer complications (41.5% vs. 64.7%, difference: 23.3%; CI 0.6%, 42.7%) and skin punctures (1.6 vs. 3.6; difference: 2.0; CI: 1.6, 2.7), and improved patient satisfaction from 4.4 to 7.7 cm (P-value - .0001). Conclusions: Following a brief US training for PIV access, EDTs showed similar success rates but US had significantly improved speed and patient satisfaction with fewer skin punctures and complications. (C) 2009 Elsevier Inc. All rights reserved.