Ultrasound-guided versus landmark approach for peripheral intravenous access by critical care nurses: a randomised controlled study

Céline Bridey, Nathalie Thilly, Thomas Lefevre, Adeline Maire-Richard, Maxime Morel, Bruno Levy, Nicolas Girerd, Antoine Kimmoun, Céline Bridey, Nathalie Thilly, Thomas Lefevre, Adeline Maire-Richard, Maxime Morel, Bruno Levy, Nicolas Girerd, Antoine Kimmoun

Abstract

Objective: Establishing a peripheral intravenous catheter (PIVC) after a long intensive care unit (ICU) stay can be a challenge for nurses, as these patients may present vascular access issues. The aim of this study was to compare an ultrasound-guided method (UGM) versus the landmark method (LM) for the placement of a PIVC in ICU patients who no longer require a central intravenous catheter (CIVC).

Design: Randomised, controlled, prospective, open-label, single-centre study.

Setting: Tertiary teaching hospital.

Participants: 114 awake patients hospitalised in ICU fulfilling the following criteria: (1) with a central venous catheter that was no longer required, (2) needing a PIVC to replace the central venous catheter and (3) with no apparent or palpable veins on upper limbs after tourniquet placement.

Intervention: Placement of a PIVC using an UGM.

Primary outcome: Number of attempts for the establishment of a PIVC in the upper limbs.

Results: 57 patients were respectively included in both the UGM group and LM group. Stasis oedema in the upper limbs was the main cause of poor venous access identified in 80% of patients. Both the number of attempts (2 (1-4), p=0.911) and catheter lifespan ((3 (1-3) days and 3 (2-3) days, p=0.719) were similar between the two groups. Catheters in the UGM group tended to be larger (p=0.059) and be associated with increased extravasation (p=0.094).

Conclusion: In ICU patients who no longer require a CIVC, use of an UGM for the establishment of a PIVC is not associated with a reduction in the number of attempts compared with LM.

Trial registration number: NCT02285712; Results.

Keywords: ultrasonography; vascular access device.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Flowchart. *One case lost in the ultrasound-guided method group. **One patient did not receive the intervention because of clinical deterioration.

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