Ultrasonography-guided peripheral ıntravenous access: Regular technique versus seldinger technique in patients with difficult vascular access

İntravenöz (IV) erişimi zor olan erişkin hastalarda ultrasonografi (US) eşliğinde periferal intravenöz (PIV) yolla standart uzunlukta kateterlerin kullandığı alışılagelmiş teknik ile 16 cm santral venöz kateterler kullanılan Seldinger tekniği randomize karşılaştırmayı amaçladık. Hastalar iki gruba ayrıldı: (1) US eşliğinde alışılagelmiş teknik ile IV erişim yapılan teknik veya (2) US eşliğinde Seldinger tekniği ile elde edilen IV erişim yapılan teknik. Birincil sonlanım olarak intravenöz erişim başarı oranları, girişim sayısı, 96 saatten uzun suren IV survi ölçüldü. İkincil sonlanım olarak, IV komplikasyon oranları ve hasta memnuniyeti değerlendirildi. Her iki grup demografik faktörler ve zor PIV erişim risk faktörleri açısından eşleştirilmiştir. Her iki grup arasında IV başarı oranı veya başarılı PIV kateter yerleştirilmesi açısından anlamlı fark bulunmamaktaydı. Seldinger tekniğiyle kateter yerleştirilen grupla karşılaştırıldığında standart teknik grubunda ortalama erişim süresi 26 ve 72 saat olarak tespit edildi. Standart teknikte ilk 24 saat içerisinde %41 oranında IV kateter başarısızlığı saptanırken Seldinger tekniği ile bu oran %4.4 olarak bulundu. Her iki grupta da ani komplikasyon oranını düşük oranda gözlemledik, bununla birlikte çalışma periyodu boyunca infeksiyöz veya trombotik kom- plikasyon tespit edilmedi. Seldinger tekniği grubunda hasta memnuniyeti standart tekniğe oranla daha yüksekti. 16 cm kateter ile US eşliğinde derin brakiyal veya bazilik ven kanülasyonu zor IV erişimi olan hastalarda santral kateter yerleştirilmesi için potansiyel olarak güvenli ve hızlı bir alternatif sunmaktadır.

Ultrasonografi eşliğinde periferal intravenöz girişim: Zor vasküler erişim olan hastalarda standart yöntem ile seldinger yönetminin karşılaştırılması

We sought to compare ultrasonography (US)-guided peripheral intravenous (PIV) access by regular technique using standard length catheters with a Seldinger technique using 16-cm central venous catheters in a randomized trial of adult patients with difficult intravenous (IV) access. Patients were randomized into two groups: (1) An US-guided IV access obtained through a regular tech- nique or (2) An US-guided IV access obtained through a Seldinger technique. Outcomes measured were IV access success rates, number of attempts after enrollment, IV survival > 96 hours. As a secondary outcomes, we recorded IV complications rates and subject satisfaction. The two groups were matched in demographics, risk factors for difficult PIV access. No significant difference of clinical importance was found between the 2 groups in IV success rate or number of successful PIV catheter placement after one and two attempts. Median duration of access was 26 vs. 72 hours in regular technique group compared with Seldinger technique group, respectively. Forty one percent of IV catheters failed within 24 hours in regular technique group, most commonly due to infiltration with only 4.4 percent in Seldinger technique group. We observed low rate of immediate complications in both groups, however no infectious or thrombotic complication during the study period. Seldinger technique group had greater patient satis- faction compared with regular technique group. US-guided deep brachial or basilic vein cannulation with a 16-cm catheter offers a potentially safe and rapid alternative to central line placement in patients with difficult IV access.

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1. Sandhu NP, Sidhu DS. Mid-arm approach to basilic and ce- phalic vein cannulation using ultrasound guidance. Br J Anaesth 2004;93:292-4.
2.McGee DM, Gould MK. Preventing complications of central venous catheterization. N Engl J Med 2003;348:1123-33.
3.Hind D, Calvert N, McWilliams R, et al. Ultrasonic locating devices for central venous cannulation: meta-analysis. Br Med J 2003;327:361-4.
4.Miller AH, Roth BA, Mills TJ, Woody JR, Longmoor CE, Foster B. Ultrasound guidance versus the landmark tech- nique for the placement of central venous catheters in the emergency department. Acad Emerg Med 2002;9:800-5.
5.Keyes LE, Frazee BW, Snoey ER, Simon BC, Christy D. Ultrasound-guided brachial and basilic vein cannulation in emergency department patients with difficult intrave- nous access. Ann Emerg Med 1999;34:711-4.
6.Costantino TG, Parikh AK, Satz WA, Fojtik JP. Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access. Ann Emerg Med 2005;46:456-61.
7.Mills CN, Otto L, Stone MB, Frazee BW. Ultrasonographically guided insertion of a 15-cm catheter into the deep bra- chial or basilic vein in patients with difficult intravenous access. Ann Emerg Med 2007;50: 68-72.
8.Stein J, George B, River G, Hebig A, McDermott D. Ultrasonographically guided peripheral intravenous can- nulation in emergency department patients with difficult intravenous access: A Randomized Trial. Ann Emerg Med 2009;54:33-9.
9. Dargin J, Rebholz C, Lowenstein R, Mitchell PM, Feldman JA. Ultrasonography-guided peripheral intravenous cath- eter survival in ED patients with difficult access Am J Emerg Med 2010;28:17
10. Catney MR, Hills S, Wakefield B, et al. Relationship be- tween peripheral intravenous catheter dwell time and the development of phlebitis and infiltration. J Infus Nurs 2001;24(5):332-41.
11. Tagalakis V, Kahn SR, Libman M, Blostein M. The epide- miology of peripheral vein infusion thrombophlebitis: a critical review. Am J Med 2002;113:146-51.
12. Homer LD, Holmes KR. Risk associated with 72- and 96- hour peripheral intravenous catheter dwell times. J Infus Nurs 1998;21(5):301-5.
13. Smith B. Peripheral intravenous catheter dwell times: a comparison of 3 securement methods for implementa- tion of a 96-hour scheduled change protocol. J Infus Nurs 2006;29(1):14-7.
14. Chinnock B, Thornton S, Hendey M. Predictors of success in nurse performed ultrasound-guided cannulation. J Emerg Med 2007;33(4):401-5.
15. Whigham CJ, Goodman CJ, Fisher RG, Greenbaum MC, Thornby JI, Thomas JW. Infectious complications of 393 peripherally implantable venous access devices in HIV- positive and HIV-negative patients. J Vasc Interv Radiol. 1999;10:71-7.
16. Loewenthal MR, Dobson PM, Starkey RE, Dagg SA, Petersen A, Boyle MJ. The peripherally inserted central catheter (PICC): a prospective study of its natural his- tory after cubital fossa insertion. Anaesth Intensive Care 2002;30:21-4.
17. Luciani A, Clement O, Halimi P, et al. Catheter-related upper extremity deep venous thrombosis in cancer pa- tients: a prospective study based on Doppler US. Radiology 2001;220:655-60.
18. Schimp VL, Munkarah AR, Morris RT, Deppe G, Malone J Jr. Upper extremity deep vein thrombosis associated with indwelling peripheral venous catheters in gynecology on- cology patients. Gynecol Oncol 2003;89:301-5.