Ultrasonographically guided insertion of a 15-cm catheter into the deep brachial or basilic vein in patients with difficult intravenous access.
OBJECTIVE
Standard length (3 to 5 cm) intravenous catheters in the deep brachial or basilic vein tend to dislodge prematurely. We assess the safety and longevity of a 15-cm catheter inserted in these veins by a novel ultrasonographically guided technique.


METHODS
This is a prospective cohort study conducted in an urban teaching emergency department (ED). Adult subjects were enrolled if 2 peripheral intravenous insertion attempts had failed. A 3.2-cm, 18-gauge catheter was first inserted into the deep brachial or basilic vein under ultrasonographic guidance. In a separate step, a wire was inserted through this catheter, and a 15-cm, 16-gauge catheter was placed over the wire and left in place for up to 3 days. Primary outcomes were time to securing access and rate of loss of access. Secondary outcomes included complication rates and subject satisfaction.


RESULTS
Twenty-five subjects were enrolled; 23 catheters were successfully placed. Median time required for initial vein cannulation was 3 minutes (interquartile range [IQR] 2 to 7 minutes) and for securing the 15-cm catheter was an additional 4 minutes (IQR 3 to 5 minutes). Median duration of access was 26 hours (IQR 10 to 47 hours). The only complication was early infiltration in 1 subject. All subjects rated satisfaction as 4 or 5 on a 5-point Likert scale.


CONCLUSIONS
We present a promising alternative to central venous catheterization in patients with difficult intravenous access. This technique appears to be fast, safe, and well tolerated by adult patients.
Mills
Christopher N
CN
Department of Emergency Medicine, Alameda County Medical Center-Highland Hospital, Oakland, CA, USA. cnmills@yahoo.com
Liebmann
Otto
O
Stone
Michael B
MB
Frazee
Bradley W
BW
D001132:Arm; D002405:Catheterization, Central Venous / Q000295:instrumentation* / Q000379:methods*; D002408:Catheters, Indwelling; D015331:Cohort Studies; D004635:Emergency Medicine / Q000379:methods; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*