An Observational Study to Examine Ultrasound-Guided Intravenous Placements in Patients With Difficult Intravenous Access

Ultrasound guided peripheral intravenous catheter placement (USGIV) has been shown to improve placement success for patients (pts) with difficult intravenous access (DIVA). We sought to determine the number of attempts by emergency medicine (EM) residents/attendings required to achieve functionality for pts with DIVA in an adult emergency department (ED).

IRB-approved, prospective, observational study. Inclusion: DIVA pts identified by nursing after failed attempts. Exclusion: Pts who were pregnant, in custody, lacking decisional capacity, or in infectious isolation. EM physicians, blinded to the specifics of data collection, placed USG IVs. Monitored, trained, competency-verified research assistants (RA’s) captured the following: training level, number of provider’s previous USGIVs performed, probe cover usage, number of attempts, vein location, successful flush and blood draw, and initial and hourly (up to 3 hrs) patency. USGIV functionality was defined as an USGIV that draws blood and flushes upon placement. Primary outcome: the mean number of attempts to achieve functionality and stratified by training level. Secondary outcome: the proportion of USGIV’s that were functional at 3 hours. Results are reported using means and proportions with 95% CI as appropriate.

170 were screened, and 113 USGIV placements met inclusion/exclusion criteria. The N (%) by post-graduate year (PGY): PGY1=44 (38.9%); PGY2=37 (32.7%); PGY3= 28(24.8%); Att=2(1.7%). Primary outcome: the mean (95%CI) # attempts overall was 1.22 (1.12,1.33) with no difference between levels of training. Overall, 3-hr patency was 104/113 =92% (95%CI 85.4, 96). Limitations: single, adult, academic ED; spectrum bias as nurses identified DIVA after their unsuccessful attempts.

In our study, we found no difference in the number of attempts to achieve a functional USGIV amongst different levels of training. The 3-hr functionality was very high, and to the best of our knowledge, has not been previously reported for ED DIVA patients.