Abstract
Background
The peripheral veins in the arms and forearms of patients with a history of intravenous
(IV) drug use may be sclerosed, calcified, or collapsed due to damage from previous
injections. These patients may consequently require alternative, more invasive types
of vascular access including central venous or intraosseous catheters.
We investigated the relationship between hand dominance and the presence of patent
upper extremity (UE) veins specifically in patients with a history of IV drug-use.
We predicted that injection into the non-dominant UE would occur with a higher frequency
than the dominant UE, leading to fewer damaged veins in the dominant UE. If hand dominance
affects which upper extremity has more patent veins, providers could focus their first
vascular access attempt on the dominant upper extremity.
Methods
Adult patients were approached for enrollment if they provided a history of IV drug
use into one of their upper extremities. Each upper extremity was examined with a
high frequency linear transducer in 3 areas: the antecubital crease, forearm and the
proximal arm. The number of fully compressible veins ≥1.8 mm in diameter was recorded for each location.
Results
The mean vein difference between the numbers of veins in the dominant versus the non-dominant
UE was −1.5789. At a .05 significance level, there was insufficient evidence to suggest the
number of compressible veins between patients' dominant and non-dominant arms was
significantly different (P = .0872.)
Conclusions
The number of compressible veins visualized with ultrasound was not greater in the
dominant upper extremity as expected. Practitioners may gain more information about
potential peripheral venous access sites by asking patients their previous injection
practice patterns.
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References
- Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access.Ann Emerg Med. 2005; 46: 456-461
- Ultrasound-guided brachial and basilic vein cannulation in emergency department patients with difficult intravenous access.Ann Emerg Med. 1999; 34: 711-714
- Ultrasound guided peripheral intravenous cannulation in emergency department patients with difficult IV access.Acad Emerg Med. 2004; 11: 581-582
- What you see (sonographically) is what you get: vein and patient characteristics associated with successful ultrasound-guided peripheral intravenous placement in patients with difficult access.Acad Emerg Med. 2009; 16: 1298-1303
- American college Of emergency physicians.Ann Emerg Med. 2009 Apr; 53: 550-570
Article Info
Publication History
Published online: February 20, 2016
Accepted:
February 17,
2016
Received in revised form:
January 27,
2016
Received:
December 15,
2015
Footnotes
☆There is no grant support or involvement.
☆☆There are no conflicts of interest.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.