title: Ultrasonographically guided insertion of a 15-cm catheter into the deep brachial or basilic vein in patients with difficult intravenous access.
abstract: 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.
authors: Department of Emergency Medicine, Alameda County Medical Center-Highland Hospital, Oakland, CA, USA. cnmills@yahoo.com
authors: Christopher N
authors: CN
authors: Mills
authors: Otto
authors: O
authors: Liebmann
authors: Michael B
authors: MB
authors: Stone
authors: Bradley W
authors: BW
authors: Frazee
mesh_terms: 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*