A randomized trial of ultrasound-guided peripheral IV catheter placement in difficult access patients using a guidewire approach.

Autor: Cochrane HK; Department of Emergency Medicine, University of Saskatchewan, 2646 Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada. Electronic address: hkc445@mail.usask.ca., Henwood PC; Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States of America. Electronic address: phenwood@bwh.harvard.edu., Platz E; Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States of America. Electronic address: eplatz@bwh.harvard.edu., Koskenoja V; Department of Emergency Medicine, UP Health System Marquette, 580 W College Ave, Marquette, MI 49855, United States of America., Landry A; Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States of America. Electronic address: ailandry@bwh.harvard.edu., Frasure SE; Department of Emergency Medicine, George Washington University Hospital, 2120 L Street NW, Suite 450, Washington, DC 20037, United States of America., Rempell JS; Department of Emergency Medicine, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ 08103, United States of America., Hoyler J; Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States of America., Baker O; Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States of America. Electronic address: obaker2@bwh.harvard.edu., Kimberly HH; Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States of America. Electronic address: hkimberly@bwh.harvard.edu.
Jazyk: angličtina
Zdroj: The American journal of emergency medicine [Am J Emerg Med] 2020 Jan; Vol. 38 (1), pp. 122-126. Date of Electronic Publication: 2019 Jul 17.
DOI: 10.1016/j.ajem.2019.07.022
Abstrakt: 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.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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