Decrease in central venous catheter placement due to use of ultrasound guidance for peripheral intravenous catheters

• Published in: The American journal of emergency medicine 2012-11, Vol.30 (9), p.1950-1954
• Main Authors: Au, Arthur K., MD, Rotte, Masashi J., MD, Grzybowski, Robert J, Ku, Bon S., MD, MPP, Fields, J. Matthew, MD
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Catheter-Related Infections - epidemiology; Catheterization, Central Venous - adverse effects; Catheterization, Central Venous - statistics & numerical data; Catheterization, Peripheral - methods; Catheterization, Peripheral - statistics & numerical data; Catheters; Emergency; Emergency and intensive care: techniques, logistics; Emergency medical care; Emergency Service, Hospital - statistics & numerical data; Humans; Intensive care medicine; Male; Medical instruments; Medical sciences; Observational studies; Patients; Perfusions. Catheterizations. Hyperbaric oxygenotherapy; Physicians; Prospective Studies; Treatment Failure; Ultrasonic imaging; Ultrasonography, Interventional - methods
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2012.04.016

Abstract Study Objectives Obtaining intravenous (IV) access in the emergency department (ED) can be especially challenging, and physicians often resort to placement of central venous catheters (CVCs). Use of ultrasound-guided peripheral IV catheters (USGPIVs) can prevent many “unnecessary” CVCs, but the true impact of USGPIVs has never been quantified. This study set out to determine the reduction in CVCs by USGPIV placement. Methods This was a prospective, observational study conducted in 2 urban EDs. Patients who were to undergo placement of a CVC due to inability to establish IV access by other methods were enrolled. Ultrasound-trained physicians then attempted USGPIV placement. Patients were followed up for up to 7 days to assess for CVC placement and related complications. Results One hundred patients were enrolled and underwent USGPIV placement. Ultrasound-guided peripheral IV catheters were initially successfully placed in all patients but failed in 12 patients (12.0%; 95 confidence interval [CI], 7.0%-19.8%) before ED disposition, resulting in 4 central lines, 7 repeated USGPIVs, and 1 patient requiring no further intervention. Through the inpatient follow-up period, another 11 patients underwent CVC placement, resulting in a total of 15 CVCs (15.0%; 95 CI, 9.3%-23.3%) placed. Of the 15 patients who did receive a CVC, 1 patient developed a catheter-related infection, resulting in a 6.7% (95 CI, 1.2%-29.8%) complication rate. Conclusion Ultrasound prevented the need for CVC placement in 85% of patients with difficult IV access. This suggests that USGPIVs have the potential to reduce morbidity in this patient population.