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

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.

• Authors: Simon A Mahler, Hao Wang, Chadwick Lester, Janice Skinner, Thomas C Arnold, Steven A Conrad
• Journal: The American journal of emergency medicine (Am J Emerg Med) Vol. 29 Issue 9 Pg. 1194-7 (Nov 2011) ISSN: 1532-8171 [Electronic] United States
• PMID: 20951527 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2011 Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Aged
• Catheterization, Peripheral (methods)
• Female
• Humans
• Male
• Middle Aged
• Ultrasonography, Interventional (methods)
• Young Adult