Making needles less prickly/The authors respond

• Published in: Canadian Medical Association journal (CMAJ) 2015-09, Vol.187 (13), p.996
• Main Authors: Lardner, David R R, Spencer, Adam O, Curtis, Sarah J, Craig, William R
• Format: Article
• Language: English
• ISSN: 0820-3946; 1488-2329

Ultrasound has a role in placing the difficult IV. A recent meta-analysis2 concluded that in patients with difficult peripheral venous access, using a direct, real-time, ultrasound-guided approach increased success rates of peripheral IV insertion when compared with the standard approach, but had no effect on the time or number of punctures to successful cannulation. In their discussion, Curtis and colleagues1 touch on whether the nurses were trained well enough, but then describe the training as "comprehensive." Based on their study design, we believe a more correct conclusion would have been: for routine IV placement in a setting where nurses perform IV cannulation infrequently, the addition of near-infrared and ultrasound technologies, when implemented without confirmation of skill acquisition and no facility for maintenance of skill, does not result in higher success rates of IV placement. We believe if investment in such technology is to be clinically successful, it must be accompanied by investment in training so that staff are able to use the technique with sufficient frequency to maintain their skills. Our conclusion regarding investment in ultrasound and near-infrared imaging for routine IV placement was in reference to our setting and other similar settings, specifically. In our setting, IV placement is a core nursing skill. Nurses in our emergency department place the IVs. As such, they are viewed as experts in starting pediatric IVs. Extrapolating from our enrolment data, we estimate that 70 IVs are started by nurses each week in the pediatric section of our department. Thus, our nurses are experienced at IV placement. Our data support this; across all arms (which showed no difference in first-attempt success rate), the range was 65.9%-74.7% success on first attempt.1