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Ultrasound Guidance for the Placement of Peripheral Intravenous Catheters

 

Am Fam Physician. 2021 Oct ;104(4):online.

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ULTRASONOGRAPHY FOR PERIPHERAL INTRAVENOUS CANNULATION

BenefitsHarms

1 in 7 were helped (higher first-attempt cannulation rate)

Not reported

14% increase in successful first-attempt cannulation

0.3 fewer attempts (mean difference)

1.5 higher patient satisfaction (mean difference)

No significant difference in procedure length

ULTRASONOGRAPHY FOR PERIPHERAL INTRAVENOUS CANNULATION

BenefitsHarms

1 in 7 were helped (higher first-attempt cannulation rate)

Not reported

14% increase in successful first-attempt cannulation

0.3 fewer attempts (mean difference)

1.5 higher patient satisfaction (mean difference)

No significant difference in procedure length

Details for This Review

Study Population: 1,860 patients from 10 studies

Efficacy End Points: Successful cannulation on the first attempt (primary); number of attempts, patient satisfaction, and procedure length (secondary)

Harm End Points: Data on harms not reported

Narrative: Peripheral intravenous cannulation is commonly performed in emergency departments and inpatient settings.1 Peripheral intravenous cannulation access can be challenging. One study reported that one out of nine patients in the emergency department met the criteria for difficult access.2 Traditionally, failure to achieve peripheral intravenous cannulation would lead to the placement of a central venous catheter.1 However, the increased availability and use of point-of-care ultrasonography may improve success rates for peripheral intravenous cannulation, with one study reporting that point-of-care ultrasound guidance reduced the need for a central venous catheter by 85% among patients with difficult access.3

This systematic review and meta-analysis included nine randomized controlled trials and one cohort study comprising 1,860 patients and compared ultrasound-guided peripheral intravenous cannulation with the palpation-only technique.4 The ultrasound operators were physicians in three studies, medical students in one study, nurses in four studies, and emergency department technicians in two studies. Most studies used a didactic

Author disclosure: No relevant financial affiliations.


Copyright © 2021 MD Aware, LLC (theNNT.com). Used with permission.

This series is coordinated by Christopher W. Bunt, MD, AFP assistant medical editor, and the NNT Group.

A collection of Medicine by the Numbers published in AFP is available at https://www.aafp.org/afp/mbtn.

References

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1. Gottlieb M, Sundaram T, Holladay D, et al. Ultrasound-guided peripheral intravenous line placement: a narrative review of evidence-based best practices. West J Emerg Med. 2017;18(6):1047–1054....

2. Fields JM, Piela NE, Au AK, et al. Risk factors associated with difficult venous access in adult ED patients. Am J Emerg Med. 2014;32(10):1179–1182.

3. Au AK, Rotte MJ, Grzybowski RJ, et al. Decrease in central venous catheter placement due to use of ultrasound guidance for peripheral intravenous catheters. Am J Emerg Med. 2012;30(9):1950–1954.

4. Tran QK, Fairchild M, Yardi I, et al. Efficacy of ultrasound-guided peripheral intravenous cannulation versus standard of care: a systematic review and meta-analysis. Ultrasound Med Biol. 2021;S0301-5629(21)00299-4.

5. McCarthy ML, Shokoohi H, Boniface KS, et al. Ultrasonography versus landmark for peripheral intravenous cannulation: a randomized controlled trial. Ann Emerg Med. 2016;68(1):10–18.

 

 

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