Volume 39, Issue 10 pp. 1985-1991

Original Research

Handheld Ultrasound

Overcoming the Challenge of Difficult Peripheral Intravenous Access in the Emergency Department

Josie Acuña MD,

Corresponding Author

Josie Acuña MD

[email protected]

orcid.org/0000-0002-8039-1819

Department of Emergency Medicine, University of Arizona, Tucson, Arizona, USA

Address correspondence to Josie Acuña, MD, Department of Emergency Medicine, University of Arizona Medical Center, PO Box 245057, Tucson, AZ 85724-5057, USA. E-mail: [email protected]Search for more papers by this author

Jacob Sorenson BS,

Jacob Sorenson BS

College of Medicine, University of Arizona, Tucson, Arizona, USA

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Anthony Gades PhD,

Anthony Gades PhD

Philips Point-of-Care Ultrasound, Bothell, Washington, USA

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Ryan Wyatt NREMT-P,

Ryan Wyatt NREMT-P

Department of Emergency Medicine, University of Arizona, Tucson, Arizona, USA

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Nicholas Stea MD,

Nicholas Stea MD

Department of Emergency Medicine, University of Arizona, Tucson, Arizona, USA

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Maili Drachman MD,

Maili Drachman MD

Department of Emergency Medicine, University of Arizona, Tucson, Arizona, USA

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Srikar Adhikari MD,

Srikar Adhikari MD

Department of Emergency Medicine, University of Arizona, Tucson, Arizona, USA

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Josie Acuña MD,

Corresponding Author

Josie Acuña MD

[email protected]

orcid.org/0000-0002-8039-1819

Department of Emergency Medicine, University of Arizona, Tucson, Arizona, USA

Jacob Sorenson BS,

Jacob Sorenson BS

College of Medicine, University of Arizona, Tucson, Arizona, USA

Search for more papers by this author

Anthony Gades PhD,

Anthony Gades PhD

Philips Point-of-Care Ultrasound, Bothell, Washington, USA

Search for more papers by this author

Ryan Wyatt NREMT-P,

Ryan Wyatt NREMT-P

Department of Emergency Medicine, University of Arizona, Tucson, Arizona, USA

Search for more papers by this author

Nicholas Stea MD,

Nicholas Stea MD

Department of Emergency Medicine, University of Arizona, Tucson, Arizona, USA

Search for more papers by this author

Maili Drachman MD,

Maili Drachman MD

Department of Emergency Medicine, University of Arizona, Tucson, Arizona, USA

Search for more papers by this author

Srikar Adhikari MD,

Srikar Adhikari MD

Department of Emergency Medicine, University of Arizona, Tucson, Arizona, USA

Search for more papers by this author

First published: 25 April 2020

https://doi.org/10.1002/jum.15303

Citations: 14

We thank Philips Ultrasound for product support. This work was presented in abstract form at the Society of Academic Emergency Medicine Annual Convention; May 2019; Las Vegas, Nevada. All of the authors of this article have reported no disclosures.

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Abstract

Objectives

The purpose of this study was to evaluate the performance of a handheld ultrasound device for difficult peripheral intravenous (PIV) access performed by nurses and paramedics in the emergency department (ED).

Methods

This was a retrospective review at an academic medical center. Participants were ED nurses and paramedics with competence in ultrasound-guided PIV placement. Participants were asked to log their use of the handheld device when used on patients deemed to have “difficult” access and complete a questionnaire, which consisted of items related to the effectiveness and ease of use of the device. Data were collected over the course of 1 year. An electronic medical record review was performed to track the success rates and the occurrence of any associated complications throughout the hospital stay.

Results

Nurses and paramedics logged a total of 483 cases in which PIV access was attempted with the handheld ultrasound device. Ninety-two percent (95% confidence interval [CI], 89%–94%) of the ultrasound-guided PIV lines attempted were placed successfully. Eighty-four percent (95% CI, 80%–87%) of the lines were placed successfully on the first attempt. In most cases (396 of 483 [82%]), no complications associated with the PIV occurred. A total of 429 questionnaires were completed over the study period. Most of the operators (84%; 95% CI, 80%–87%) stated that the handheld device was adequate to perform ultrasound-guided PIV access.

Conclusions

The handheld ultrasound device performed well in terms of usability and reliability for PIV access.

References

1Alexandrou E, Ray-Barruel G, Carr PJ, et al. International prevalence of the use of peripheral intravenous catheters. J Hosp Med 2015; 10: 530–533.
10.1002/jhm.2389
PubMed Web of Science® Google Scholar
2Witting MD. IV access difficulty: incidence and delays in an urban emergency department. J Emerg Med 2012; 42: 483–487.
10.1016/j.jemermed.2011.07.030
PubMed Web of Science® Google Scholar
3Fields JM, Piela NE, Au AK. Risk factors associated with difficult venous access in adult ED patients. Am J Emerg Med 2014; 32: 1179–1182.
10.1016/j.ajem.2014.07.008
PubMed Web of Science® Google Scholar
4Stolz LA, Stolz U, Howe C, Farrell IJ, Adhikari S. Ultrasound-guided peripheral venous access: a meta-analysis and systematic review. J Vasc Access 2015; 16: 321–326.
10.5301/jva.5000346
PubMed Web of Science® Google Scholar
5Shokoohi H, Boniface K, McCarthy M, et al. Ultrasound-guided peripheral intravenous access program is associated with a marked reduction in central venous catheter use in noncritically ill emergency department patients. Ann Emerg Med 2013; 61: 198–203.
10.1016/j.annemergmed.2012.09.016
PubMed Web of Science® Google Scholar
6Egan G, Healy D, O'Neill H, Clarke-Moloney M, Grace PA, Walsh SR. Ultrasound guidance for difficult peripheral venous access: systematic review and meta-analysis. Emerg Med J 2013; 30: 521–526.
10.1136/emermed-2012-201652
PubMed Web of Science® Google Scholar
7Van Loon FH, van Hooff L, de Boer HD, et al. The modified A-DIVA scale as a predictive tool for prospective identification of adult patients at risk of a difficult intravenous access: a multicenter validation study. J Clin Med 2019; 8: 144.
10.3390/jcm8020144
Web of Science® Google Scholar
8Kuo CC, Wu CY, Feng IJ, Lee WJ. Efficacy of ultrasound-guided peripheral intravenous access: a systematic review and meta-analysis [in Chinese]. Hu Li Za Zhi 2016; 63: 89–101.
PubMed Google Scholar
9Blaivas M, Brannam L, Theodoro D. Ultrasound image quality comparison between an inexpensive handheld emergency department (ED) ultrasound machine and a large mobile ED ultrasound system. Acad Emerg Med 2004; 11: 778–781.
10.1197/j.aem.2003.12.030
PubMed Web of Science® Google Scholar
10Baugher KM, Euerle BD, Sommerkamp SK, Witting MD. Image quality evaluation of a portable handheld ultrasound machine for the focused assessment with sonography for trauma examination. Am J Emerg Med 2014; 32: 389–391.
10.1016/j.ajem.2013.12.034
PubMed Web of Science® Google Scholar
11Piredda M, Biagioli V, Barrella B, et al. Factors affecting difficult peripheral intravenous cannulation in adults: a prospective observational study. J Clin Nurs 2017; 26: 1074–1084.
10.1111/jocn.13444
PubMed Web of Science® Google Scholar
12McCarthy ML, Shokoohi H, Boniface KS, et al. Ultrasonography versus landmark for peripheral intravenous cannulation: a randomized controlled trial. Ann Emerg Med 2016; 68: 10–18.
10.1016/j.annemergmed.2015.09.009
PubMed Web of Science® Google Scholar
13Shokoohi H, Boniface KS, Kulie P, Long A, McCarthy M. The utility and survivorship of peripheral intravenous catheters inserted in the emergency department. Ann Emerg Med 2019; 74: 381–390.
10.1016/j.annemergmed.2019.02.003
PubMed Web of Science® Google Scholar
14Walker E. Piloting a nurse-led ultrasound cannulation scheme. Br J Nurs 2009; 18: 854–859.
10.12968/bjon.2009.18.14.43352
PubMed Google Scholar
15Brannam 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; 11: 1361–1363.
10.1197/j.aem.2004.08.027
PubMed Web of Science® Google Scholar
16Bauman M, Braude D, Crandall C. Ultrasound-guidance vs standard technique in difficult vascular access patients by ED technicians. Am J Emerg Med 2009; 27: 135–140.
10.1016/j.ajem.2008.02.005
PubMed Web of Science® Google Scholar
17Costantino TG, Parikh AK, Satz WA, Fojtiik JP. Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access. Ann Emerg Med 2005; 46: 456–461.
10.1016/j.annemergmed.2004.12.026
PubMed Web of Science® Google Scholar
18Stein J, George B, River G, Hebig A, McDermott D. Ultrasonographically guided peripheral intravenous cannulation in emergency department patients with difficult intravenous access: a randomized trial. Ann Emerg Med 2009; 54: 33–40.
10.1016/j.annemergmed.2008.07.048
PubMed Web of Science® Google Scholar
19Weiner SG, Sarff AR, Esener DE, et al. Single-operator ultrasound guided intravenous line placement by emergency nurses reduces the need for physician intervention in patients with difficult-to-establish intravenous access. J Emerg Med 2013; 44: 653–660.
10.1016/j.jemermed.2012.08.021
PubMed Web of Science® Google Scholar
20Fields MJ, Dean AJ, Todman RW, et al. The effect of vessel depth, diameter, and location on ultrasound-guided peripheral intravenous catheter longevity. Am J Emerg Med 2012; 30: 1134–1140.
10.1016/j.ajem.2011.07.027
PubMed Web of Science® Google Scholar

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Volume39, Issue10

October 2020

Pages 1985-1991

Handheld Ultrasound

Overcoming the Challenge of Difficult Peripheral Intravenous Access in the Emergency Department

Abstract

Objectives

Methods

Results

Conclusions

References

Citing Literature

References

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Handheld Ultrasound

Overcoming the Challenge of Difficult Peripheral Intravenous Access in the Emergency Department

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