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Short- vs long-axis approach to ultrasound-guided peripheral intravenous access: a prospective randomized study

Published:October 18, 2010DOI:https://doi.org/10.1016/j.ajem.2010.07.015

      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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      References

        • Chinnock B.
        • Thornton S.
        • Hendey G.W.
        Predictors of success in nurse-performed ultrasound-guided cannulation.
        J Emerg Med. 2007; 33: 401-405
        • Keyes L.E.
        • Bradley W.F.
        • Snoey E.R.
        • et al.
        Ultrasound-guided brachial and basilic vein cannulation in emergency department patients.
        Ann Emerg Med. 1999; 34: 711-714
        • Constantino T.G.
        • Parikh A.K.
        • Satz W.A.
        • et al.
        Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access.
        Ann Emerg Med. 2005; 46: 456-461
        • Constantino T.G.
        • Fojtik J.P.
        Success rate of peripheral IV catheter insertion by emergency physicians using ultrasound guidance.
        Acad Emerg Med. 2003; 10 ([abstract]): 487
        • Brannam L.
        • Blaivas M.
        • Lyon M.
        • et al.
        Emergency nurses' utilization of ultrasound guidance for placement of peripheral intravenous lines in difficult-access patients.
        Acad Emerg Med. 2004; 11: 1361-1363
        • Mahler S.A.
        • Wang H.
        • Lester C.
        • et al.
        Ultrasound-guided peripheral intravenous access in the emergency department using a modified Seldinger technique.
        J Emerg Med. 2010; 39: 325-329
        • Steele R.
        • Babcock C.
        Central line mechanical complication rate in emergency medicine patients.
        Acad Emerg Med. 2008; 8: 204-207
        • Legler D.
        • Nugent M.
        Doppler localization of the internal jugular vein facilitates central venous cannulation.
        Annesthesiology. 1984; 60: 481-482
        • Blaivas M.
        • Adhikari S.
        An unseen danger: frequency of posterior vessel wall penetration by needles during attempts to place internal jugular vein central catheters using ultrasound guidance.
        Crit Care Med. 2009; 37: 2345-2349
        • Resnick J.R.
        • Cydulka R.K.
        • Donato J.
        • et al.
        Success of ultrasound-guided peripheral intravenous access with skin marking.
        Acad Emerg Med. 2008; 15: 1-8