The Utility and Survivorship of Peripheral Intravenous Catheters Inserted in the Emergency Department

Shokoohi, Hamid; Boniface, Keith; Kulie, Paige; Long, Andrew; McCarthy, Melissa L.

doi:10.1016/j.annemergmed.2019.02.003

Cited by 12 publications

(13 citation statements)

References 20 publications

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“…The patient characteristics in our sample population were comparable to those of other major studies assessing the use of ultrasound for obtaining PIV access . From our data, it was determined that when the handheld device was used, 92% of the ultrasound‐guided peripheral venous lines attempted were placed successfully.…”

Section: Discussionsupporting

confidence: 66%

Handheld Ultrasound

Acuña

Sorenson

Gades

et al. 2020

J of Ultrasound Medicine

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Objectives-The purpose of this study was to evaluate the performance of a handheld ultrasound device for difficult peripheral intravenous (PIV) access performed by nurses and paramedics in the emergency department (ED). Methods-This was a retrospective review at an academic medical center. Participants were ED nurses and paramedics with competence in ultrasound-guided PIV placement. Participants were asked to log their use of the handheld device when used on patients deemed to have "difficult" access and complete a questionnaire, which consisted of items related to the effectiveness and ease of use of the device. Data were collected over the course of 1 year. An electronic medical record review was performed to track the success rates and the occurrence of any associated complications throughout the hospital stay. Results-Nurses and paramedics logged a total of 483 cases in which PIV access was attempted with the handheld ultrasound device. Ninety-two percent (95% confidence interval [CI], 89%-94%) of the ultrasound-guided PIV lines attempted were placed successfully. Eighty-four percent (95% CI, 80%-87%) of the lines were placed successfully on the first attempt. In most cases (396 of 483 [82%]), no complications associated with the PIV occurred. A total of 429 questionnaires were completed over the study period. Most of the operators (84%; 95% CI, 80%-87%) stated that the handheld device was adequate to perform ultrasound-guided PIV access. Conclusions-The handheld ultrasound device performed well in terms of usability and reliability for PIV access.

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Section: Discussionsupporting

confidence: 66%

Handheld Ultrasound

Acuña

Sorenson

Gades

et al. 2020

J of Ultrasound Medicine

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“…Other studies described higher infiltrations, occlusions, 24 and dislocations rates. 18,23 than those found in this trial.…”

Section: Discussioncontrasting

confidence: 58%

“…Studies evaluating the use and survival of PIVCs positioned in ED confirm these data. 23 Between the two different ultrasound approaches, the occurrence of complications during the follow-up was similar. Grade 1 and 2 phlebitis occurred without any significant difference between the two groups.…”

Section: Discussionmentioning

confidence: 85%

Ultrasound-guided peripheral intravenous catheters insertion in patient with difficult vascular access: Short axis/out-of-plane versus long axis/in-plane, a randomized controlled trial

et al. 2021

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Purpose: The aim of this study was to evaluate the rate of successful peripheral cannulation between short-axis and long-axis ultrasound guided techniques. Methods: A single-center, two-arm randomized controlled, intention-to-treat, open-label study was conducted at the Emergency Department, between August and November 2020. Patients requiring a peripheral intravenous catheter insertion and identified as having a difficult intravascular access, were enrolled and followed for up to 96 h. The primary endpoint was the correct placement of the peripheral intravenous catheter. The secondary endpoints were number of venipunctures, intra-procedural pain, local complications, and positive blood return during the follow up. Results: A total of 283 patients were enrolled: 141 subjects were randomized to the short-axis and 142 to the long-axis group. Success rate was 96.45% (135/141; 95% CI, 91.92%–98.84%) in the short-axis group compared with 92.25% (132/142; 95% CI, 86.56%–96.07%) in the long-axis group ( p = 0.126). No significant differences were found in terms of intraprocedural pain and local complications. Higher rate of positive blood return at 72 h [3/17 long-axis, 14/17 short-axis ( p = 0.005)] and 96 h [1/10 long-axis, 9/10 short-axis 96 h, ( p = 0.022)] was found for the short-axis group. Conclusions: No differences were found between short-axis and long-axis techniques in terms of success rate, intraprocedural pain, and local complications. Despite this, a slightly higher success rate, a lower number of venipunctures, and a higher rate of positive blood return at 72 and 96 h together with an easier ultrasound technique could suggest a short-axis approach.

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“…[11][12][13][14] Definition of DIVA Forty-three publications provided a definition of DIVA in adult, pediatric, or mixed populations. Of the 43 publications reporting a DIVA definition , 35 publications reported a definition for adult patients only [9][10][11][12]15,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][33][34][35][36][37][38][40][41][42][43][45][46][47][48][49] 5 publications reported a definition for pediatric patients only, 13,14,31,44,50 and in 3 publications the age of the included patients was not clear. 16,32,39 In terms of geographic origin, 27 studies were from the US, 11 were European, 2 were from the Middle East, 2 were from East Asia, and 1 was from the Caribbean.…”

Section: Prevalence Of Divamentioning

confidence: 99%

“…Prospective: 5 publications 16,22,25,34,47 RCT: 4 publications 28,44,49,50 Retrospective: 2 publications 15,35 Literature review: 1 publication 30 Secondary analysis of prospective data: 1 publication 23 Cross-sectional: 1 publication 6 Theme 3: Personal history of DIVA 11 Prospective: 5 publications 18,25,34,37,38 RCT: 4 publications 41,42,44,48 Secondary analysis of prospective data: 1 publication 23 Cross-sectional: 1 publication 6 Theme 4: History of ESRD, IV drug abuse, or other chronic medical condition…”

Section: Prevalence Of Divamentioning

confidence: 99%

Defining difficult intravenous access (DIVA): A systematic review

et al. 2021

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Background: The term “difficult intravenous access” (DIVA) is commonly used but not clearly defined. Repeated attempts at peripheral intravenous catheter (PIVC) insertion can be a traumatic experience for patients, leading to sub-optimal clinical and economic outcomes. We conducted a systematic literature review (SLR) to collate literature definitions of DIVA, with the aim of arriving at an evidence-driven definition. Methods: The SLR was designed to identify clinical, cost, and quality of life publications in patients requiring the insertion of a PIVC in any setting, including studies on US-guidance and/or guidewire, and studies with no specific intervention. The search was restricted to English language studies published between 1st January 2010 and 30th July 2020, and the Ovid platform was used to search several electronic databases, in addition to hand searching of clinical trial registries. Results: About 121 studies were included in the SLR, of which 64 reported on the objectives relevant to this manuscript. Prevalence estimates varied widely from 6% to 87.7% across 19 publications, reflecting differences in definitions used. Of 43 publications which provided a definition of DIVA, six key themes emerged. Of these, themes 1–3 (failed attempts at PIV access using traditional technique; based on physical examination findings for example no visible or palpable veins; and personal history of DIVA) were covered by all but one publication. Following a failed insertion attempt, the most common number of subsequent attempts was 3, and it was frequently reported that a more experienced clinician would attempt to gain access after multiple failed attempts. Conclusions: Considering the themes identified, an evidence-driven definition of DIVA is proposed: “when a clinician has two or more failed attempts at PIV access using traditional techniques, physical examination findings are suggestive of DIVA (e.g. no visible or palpable veins) or the patient has a stated or documented history of DIVA.”

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The Utility and Survivorship of Peripheral Intravenous Catheters Inserted in the Emergency Department

Cited by 12 publications

References 20 publications

Handheld Ultrasound

Handheld Ultrasound

Ultrasound-guided peripheral intravenous catheters insertion in patient with difficult vascular access: Short axis/out-of-plane versus long axis/in-plane, a randomized controlled trial

Defining difficult intravenous access (DIVA): A systematic review

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