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LETTER TO THE EDITOR
Year : 2011  |  Volume : 1  |  Issue : 2  |  Page : 170-171

Ultrasonography-guided peripheral intravenous catheter in emergency department patients with difficult access


Intensive Care Unit, Universitary Hospital Insular in Gran Canaria, Las Palmas de Gran Canaria, Spain

Date of Web Publication12-Sep-2011

Correspondence Address:
Luciano Santana-Cabrera
Avenida Marítima del Sur s/n, Las Palmas de Gran Canaria, Canary Islands, 35016
Spain
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5151.84812

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How to cite this article:
Santana-Cabrera L, Pérez-Acosta G, Martínez-Cuéllar S, Sánchez-Palacios M. Ultrasonography-guided peripheral intravenous catheter in emergency department patients with difficult access. Int J Crit Illn Inj Sci 2011;1:170-1

How to cite this URL:
Santana-Cabrera L, Pérez-Acosta G, Martínez-Cuéllar S, Sánchez-Palacios M. Ultrasonography-guided peripheral intravenous catheter in emergency department patients with difficult access. Int J Crit Illn Inj Sci [serial online] 2011 [cited 2019 Dec 8];1:170-1. Available from: http://www.ijciis.org/text.asp?2011/1/2/170/84812

Sir,

Emergency nurses (ENs) place peripheral intravenous (IV) lines, but if repeated attempts fail, emergency physicians have to obtain peripheral or central access. Some patients such as those who are obese, chronically ill, hypovolemic, IV drug users, or those with vascular pathology may prove exceedingly difficult for peripheral IV placement.

Several studies have evaluated the use of ultrasound (US) guidance for central venous access. [1],[2] Also,this technique has been applied by peripheral vein brachial and basilic veinchanneling by doctors and nurses in emergency department (ED) patients showing aconsiderable profit. [3],[4],[5]

These studies have evaluated US-guided peripheral IV line placement in a group of ED patients, the majority of whom were IV drug users or significantly obese. The lines were placed by emergency physicians with a reported success rate of > 90%. [3] These studies involved emergency physicians using US to place peripheral lines even though the initial attempts were made by the nursing staff.

With this method the only complication is arterial puncture and nerve contact, and only a very small percentage of patients require a central line. [4] However, placement of a central line is associated with a greater than 15% rate of significant complications, including arterial puncture, pneumothorax, deep vein thrombosis and infection. [5]

Our experience is limited, but this is of higher quality when inserting catheters, (less time, a more direct technique, fewer attempts), particularly in overweight patients withedema when vascular access is very limited [Figure 1].
Figure 1: Entry via cephalic catheter (arrow)

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Therefore, in patients with difficult access who are admitted to an intensive care setting or in whom there is a high potential for clinical deterioration, it may be prudent to consider placing a central line rather than attempting US-guided peripheral IV access in the ED. Although the percentage of difficult-access patients who go on to receive a central line probably varies from one ED to another.

In conclusion, US-guided peripheral IV access is more successful than traditional "blind" techniques, requires less time, decreases the number of percutaneous punctures, and improves patient satisfaction in the group of patients who have difficult intravenous access.

 
   References Top

1.Miller AH, Roth BA, Mills TJ, Woody JR, Longmoor CE, Foster B. Ultrasound guidance versus the landmark technique for the placement of central venous catheters in the emergency department. Acad Emerg Med 2002;9:800-5.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Hrics P, Wilber S, Blanda MP, Gallo U. Ultrasound-assisted internal jugular vein catheterization in the ED. Am J Emerg Med 1998;16:401-3.  Back to cited text no. 2
[PUBMED]    
3.Keyes LE, Frazee BW, Snoey ER, Simon BC, Christy D. Ultrasound-guided brachial and basilic vein cannulation in emergency department patients with difficult intravenous access. Ann Emerg Med 1999;34:711-4.  Back to cited text no. 3
[PUBMED]    
4.Costantino TG, Parikh AK, Satz WA, Fojtik JP. Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access. Ann Emerg Med 2005;46:456-61.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Dargin JM, Rebholz CM, Lowenstein RA, Mitchell PM, Feldman JA. Ultrasonography-guided peripheral intravenous catheter survival in ED patients with difficult access. Am J Emerg Med 2010;28:1-7.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  


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