Abstract
Objective
The objective of the study was to determine if the short-axis approach and long-axis
approach to ultrasound-guided peripheral intravenous access (USGPIV) differ in success
rate, catheter insertion time, and number of needle sticks.
Methods
A convenience sample of emergency department patients aged 18 to 65 years with difficult
IV access (2 or more failed landmark attempts) was prospectively randomized to short-axis
or long-axis USGPIV. Time from skin puncture to catheter insertion (insertion time)
and number of needle sticks were recorded. Number of needle sticks and insertion time
were compared using Mann-Whitney U tests.
Results
Forty subjects were enrolled; 20 were randomized to the short-axis and 20 to the long-axis
approach. Success rate was 95% (19/20; 95% confidence interval, 85%-100%) in the short-axis
group compared with 85% (17/20; 95% confidence interval, 69%-100%) in the long-axis
group. All 3 subjects with failed IV placement in the long-axis group had successful
rescue USGPIV placement in short axis. Median insertion time was 34 seconds (interquartile
range, 35 seconds) for the short-axis group compared with 91 seconds (interquartile
range, 59 seconds) for the long-axis group (P = .02). Mean number of needle sticks was 1.5 (±SD 0.7) in the short-axis group compared
with 1.4 (±SD 0.7) in the long-axis group (P = .82).
Conclusions
Short-axis USGPIV technique required less insertion time than the long-axis technique.
Success rate was higher in the short-axis group, but this difference was not statistically
significant. However, all of the failed IVs in the long axis were rescued successfully
in short axis.
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Article Info
Publication History
Published online: October 18, 2010
Accepted:
July 23,
2010
Received in revised form:
July 22,
2010
Received:
May 17,
2010
Footnotes
☆Presented at the Society of Academic Emergency Medicine Annual Meeting, Phoenix, AZ, June 2010.
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
