Nurse-Performed Ultrasound-Guided Technique for Difficult Peripheral Intravenous Access in Critically Ill Patients: A Randomized Controlled Trial

Abstract

Highlights Abstract Purpose: The aim of this study was to compare nurse-performed ultrasound (US)-guided technique with standard of care (SOC) technique for difficult peripheral intravenous (PIV) access among patients admitted to the intensive care unit (ICU). Materials and Methods: This was a randomized, prospective, open-label single-site study. ICU nurses completed a standardized training program for US-guided PIV access placement before patient enrollment. ICU patients with difficult PIV access were randomized to either nurse-performed US-guided technique or SOC technique. Primary outcome was success rate on the first attempt. Secondary outcomes were success rate after 2 attempts and frequency of complications after successful placement. Results: A total of 60 patients were enrolled; 30 were randomized to receive US-guided technique, and 30 to SOC technique. Success rate on the first attempt was significantly higher with US-guided technique compared with SOC technique (70% vs 40%; P < 0.05). Success rates after 2 attempts were 73.3% for US-guided technique and 46.6% for SOC technique (P = 0.065). Extravasation after successful placement occurred in 13.6% of patients with US-guided technique, and 28.6% of patients with SOC technique (P = 0.394). Conclusions: Among ICU patients with difficult PIV access, US-guided PIV access placement by nurses who underwent standardized training was more successful than placement with SOC technique.

The Efficacy of Nurse-Performed Ultrasound Guidance Compared with the Conventional Cannulation Technique in Patients with Difficult Peripheral Intravenous Access: A Systematic Review

“…Studies already exist concerning the efficacy of UG in patients with DIVA, however, other professionals such as doctors and emergency technicians perform this procedure. Two out of the three RCTs included in this study proved that nurse-performed UG significantly increases the success rate of intravenous cannulation when compared with the CT. 21,23 The third RCT article did not have a significant difference between the two methods. 22 Regarding the primary outcome, it seems evident that the use of UG performed by expertly trained nurses increases the success rate already on the first attempt in patients with DIVA.…”

“…The third article is a Japanese RCT from 2020. 23 This study compares nurse-performed UG with the CT in DIVA patients admitted to the ICU. The success rate on the first attempt was significantly higher in the UG group compared with the CT group (70% vs. 40%, P = .0379).…”

“…The French and the Japanese RCTs measured the incidence of extravasation complications occurring in each of the two groups. 22,23 The French study, Bridey et al showed that the incidence of extravasation was more frequent in the UG group compared with the CT group but with no significant difference. 22 Bridey et al state that the reason for more frequency of extravasation in the UG group was due to the use of catheters with insufficient length for the depth of the punctured veins.…”

“…Furthermore, they refer to the same three RCT studies, which are included in this study and specify that these studies are the only RCT’s that reported complications or adverse events. 21-23 Given that our study investigated the occurrence of complications, we can state on behalf of the few existing RCT studies on this subject, that there is a need for more studies investigating this important topic. Tran et al mention Nishizawa et al to be the most recent RCT study existing, which gives us a clear indication that our study contains the three newest RCT studies on this topic.…”

“…On the contrary, the Japanese study Nishizawa et al had fewer occurrences of extravasation in the UG group compared with the CT group, but did not have any significant difference either. 23 Nishizawa et al refer to the French RCT and explain the importance of using the right catheter length. 22 The basilic or cephalic veins, which anatomically run deeper, are most often selected when using the UG procedure.…”