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Ultrasound-Guided Peripheral Venous Access in Severely Ill Patients With Suspected Difficult Vascular PunctureUltrasound for Peripheral Venous Access in ICU FREE TO VIEW

Thomas Kerforne, MD; Franck Petitpas, MD; Denis Frasca, MD; Véronique Goudet, MD; René Robert, MD; Olivier Mimoz, PhD
Author and Funding Information

From the Centre Hospitalier Universitaire de Poitiers (Drs Kerforne, Petitpas, Frasca, Goudet, Robert, and Mimoz); INSERM ERI 23 (Drs Petitpas, Frasca, and Mimoz); and Université de Poitiers (Drs Frasca, Goudet, Robert, and Mimoz), UFR de Médecine-Pharmacie.

Correspondence to: Olivier Mimoz, PhD, Service d’Anesthésie-Réanimation, Centre Hospitalier Universitaire, Poitiers, France; e-mail: o.mimoz@chu-poitiers.fr


Funding/Support: This study was funded by the University Hospital of Poitiers.

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(1):279-280. doi:10.1378/chest.11-2054
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In EDs, the use of ultrasonography increases successful cannulation rates in difficult-to-achieve peripheral venous access.1,2 Its value in ICU patients has never been explored in a randomized trial.3

Sixty adults considered as having difficult-to-achieve peripheral venous access by an attending nurse were included in this study. Difficult-to-achieve peripheral venous access was defined as the absence of a vein easily visible or palpable in both arms after tourniquet placement. Patients were randomized to one of two groups according to the method used for catheter insertion. In the real-time ultrasound-guidance group, vessels were searched for in their suspected anatomic position using a Vivid e Ultrasound machine (General Electric) and a 10-MHz linear transducer. Veins were identified by their ease of collapse after mild probe pressure. Venous anatomy was considered to be adequate when the vessel diameter measured at least 2.5 mm in the transverse plane. In the traditional approach group, another nurse (different from the one who included the patient) performed the catheter placement using palpation and landmark guidance. In each group, the operator had two attempts to succeed. After two cannulation failures, the patient was switched to the other group.

Patients’ characteristics were comparable in the two groups (Table 1). Successful cannulation rates were higher (P = .02) in the ultrasound-guidance group than in the traditional-approach group (Table 1). Of the nine catheters that could not be inserted using ultrasonography, only two were successfully inserted using the traditional approach. By contrast, 15 of the 19 catheters that could not be inserted using the traditional approach were successfully inserted with ultrasonography. Overall, 36 catheters were successfully inserted with the ultrasound-guidance technique and 13 with the traditional approach. Time for cannulation was similar between the two study groups.

Table Graphic Jump Location
Table 1 —Patients’ Characteristics and Main Results by Insertion Technique

Data are provided as No. (%) or Mean ± SD unless otherwise indicated. NA = not applicable.

a 

Number of patients with successful cannulation in each study group.

b 

Total number of patients in each study group.

To our knowledge, this study is the first randomized controlled trial performed in the ICU setting comparing ultrasound-guidance technique to the traditional approach for peripheral venous catheter placement in patients with suspected difficult peripheral vascular access. The ultrasound-guidance technique was more successful without increasing cannulation time despite the use of additional equipment. This technique allowed for a high success rate even for patients having two failures with the traditional approach. In addition to the increased success rate for vein cannulation, the use of ultrasonography may have other potential advantages, including shorter time for successful cannulation of the vein, fewer skin punctures, fewer complications, and finally increased patient satisfaction.4 Ultrasonography is now available in many hospitals worldwide, and most ICUs have their own equipment. Because caregivers with no experience with ultrasonography can be easily and quickly (less than 2 h) trained to perform the technique, becoming almost as efficient as experts, ultrasonography should be recommended to help peripheral venous insertion in patients with anticipated difficult vascular access.5

Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or in the preparation of the manuscript.

Other contributions: We thank all of the nurses in the surgical ICU of the University Hospital of Poitiers, France, who have participated in this work. This study is registered with the Community Clinical Trial System (EudraCT) (eudract.ema.europa.eu) as EUDRACT 2010-A01012-37.

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;465:456-461 [PubMed] [CrossRef]
 
Mills CN, Liebmann O, Stone MB, Frazee BW. Ultrasonographically guided insertion of a 15-cm catheter into the deep brachial or basilic vein in patients with difficult intravenous access. Ann Emerg Med. 2007;501:68-72 [PubMed]
 
Gregg SC, Murthi SB, Sisley AC, Stein DM, Scalea TM. Ultrasound-guided peripheral intravenous access in the intensive care unit. J Crit Care. 2010;253:514-519 [PubMed]
 
Bauman M, Braude D, Crandall C. Ultrasound-guidance vs. standard technique in difficult vascular access patients by ED technicians. Am J Emerg Med. 2009;272:135-140 [PubMed]
 
Brannam L, Blaivas M, Lyon M, Flake M. Emergency nurses’ utilization of ultrasound guidance for placement of peripheral intravenous lines in difficult-access patients. Acad Emerg Med. 2004;1112:1361-1363 [PubMed]
 

Figures

Tables

Table Graphic Jump Location
Table 1 —Patients’ Characteristics and Main Results by Insertion Technique

Data are provided as No. (%) or Mean ± SD unless otherwise indicated. NA = not applicable.

a 

Number of patients with successful cannulation in each study group.

b 

Total number of patients in each study group.

References

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;465:456-461 [PubMed] [CrossRef]
 
Mills CN, Liebmann O, Stone MB, Frazee BW. Ultrasonographically guided insertion of a 15-cm catheter into the deep brachial or basilic vein in patients with difficult intravenous access. Ann Emerg Med. 2007;501:68-72 [PubMed]
 
Gregg SC, Murthi SB, Sisley AC, Stein DM, Scalea TM. Ultrasound-guided peripheral intravenous access in the intensive care unit. J Crit Care. 2010;253:514-519 [PubMed]
 
Bauman M, Braude D, Crandall C. Ultrasound-guidance vs. standard technique in difficult vascular access patients by ED technicians. Am J Emerg Med. 2009;272:135-140 [PubMed]
 
Brannam L, Blaivas M, Lyon M, Flake M. Emergency nurses’ utilization of ultrasound guidance for placement of peripheral intravenous lines in difficult-access patients. Acad Emerg Med. 2004;1112:1361-1363 [PubMed]
 
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