A randomized trial of ultrasound-guided peripheral IV catheter placement in difficult access patients using a guidewire approach.
Publication/Presentation Date
1-1-2020
Abstract
OBJECTIVE: The purpose of this pilot study was to investigate whether use of a guidewire improves successful placement of ultrasound-guided peripheral IVs (PIV) in difficult intravenous access patients in the emergency department (ED).
METHODS: This was an unblinded, prospective, randomized trial performed by emergency medicine (EM) clinicians at a single academic ED. Eligible participants were randomized to ultrasound-guided PIV placement with or without the use of a guidewire. PIV access was obtained using the Accucath™ 20 gauge × 5.7 cm catheters by way of deployment or non-deployment of the guidewire. Primary outcome measure was first-pass success rate and secondary outcomes included number of attempts, complication rates, and clinician reported ease of insertion.
RESULTS: Seventy patients were enrolled and 69 were included in the final analysis. Thirty-four participants were randomized to use of guidewire and 35 to no guidewire. First-pass success rates were similar with and without guidewire use, 47.1% vs. 45.7%, (p = 0.9). There were no differences found in median number of attempts between the two techniques, 2 (IQR 1-2) vs 2 (IQR 1-2), (p = 0.60). The complication rates were similar, 15% vs. 29% (p = 0.25). Clinicians reported no difference in ease of insertion between methods on a 5-point Likert Scale, mean 2.6 vs 2.7 (p = 0.76).
DISCUSSION: In this pilot study comparing ultrasound-guided PIV placement in ED patients using an integrated guidewire versus no guidewire, there was no significant difference in first-pass success, number of attempts, or complication rates. This study provides preliminary data for further investigations.
Volume
38
Issue
1
First Page
122
Last Page
126
ISSN
1532-8171
Published In/Presented At
Cochrane, H. K., Henwood, P. C., Platz, E., Koskenoja, V., Landry, A., Frasure, S. E., Rempell, J. S., Hoyler, J., Baker, O., & Kimberly, H. H. (2020). A randomized trial of ultrasound-guided peripheral IV catheter placement in difficult access patients using a guidewire approach. The American journal of emergency medicine, 38(1), 122–126. https://doi.org/10.1016/j.ajem.2019.07.022
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
31349906
Department(s)
Administration and Leadership
Document Type
Article