Authors: McCarthy ML et al., Ann Emerg Med 2015 Oct 13;
A large trial shows that ultrasound helps with moderate or difficult anticipated IV access when lines are placed by emergency department technicians.
Multiple small studies since 2005 have shown that ultrasound guidance improves success of peripheral intravenous (IV) line placement when access is difficult. These researchers randomized 1189 patients to ultrasound-guided or traditional peripheral IV cannulation performed by emergency department technicians. Patients were stratified into three groups according to anticipated difficulty of access as assessed by technicians before randomization: difficult (could not see or palpate a vein in either arm), moderately difficult (could see or palpate 1 or more veins but thought access would be difficult with the landmark approach), or not difficult (could see or palpate 1 or more veins and thought access with the landmark approach would be easy).
The initial success rate was higher with ultrasound guidance in cases with anticipated difficult access (48.0 more successes per 100 tries) or moderately difficult access (10.2 more successes per 100 tries), whereas the traditional technique was more successful in cases with anticipated easy access (10.6 more successes per 100 tries).
There’s no news here regarding use of ultrasound for peripheral IV access: It helps when access is anticipated to be difficult or moderately difficult, but gets in the way when access is anticipated to be easy. What’s interesting to me about this study is that all of the procedures were done by technicians, not RNs or MDs. A broader array of healthcare workers should be trained to use ultrasound for procedures they are allowed to perform, and regions that allow only RNs and MDs to manage IV catheters should strongly reconsider that stance.