title: A randomized controlled trial comparing one-operator versus two-operator technique in ultrasound-guided basilic vein cannulation.
abstract: The basilic vein offers an alternative site for peripheral intravenous access for emergency access. The use of a two-operator ultrasound-guided basilic vein cannulation technique has been shown to be a safe and effective technique for use on Emergency Department patients. However, the one-operator technique is more customary by other services. We sought to compare the more customary one-person technique to the two-person technique in basilic vein cannulation in novice operators. This was a prospective, randomized controlled trial of two techniques of ultrasound-guided basilic vein cannulation (one-operator vs. two-operators) in healthy adult volunteers. Each volunteer underwent each technique, one technique on each arm. We selected the initial arm and technique using computer-generated block randomization. In the one-operator technique, a single operator held the transducer in transverse short-axis plane while attempting cannulation using a 20-gauge, 1.88-inch catheter. In the two-operator technique, a second operator held the transducer in place while the first operator attempted cannulation. The primary outcome variable was first-attempt cannulation success. Secondary outcome variables were overall success, number of attempts, time-to-cannulation, complications, and ease-of-technique rated by the operators. There were 32 subjects enrolled. One-operator first-attempt success was 18/32 (56%); two-operator was 21/32 (65%), with a mean difference in proportion of -9% (95% confidence interval [CI] -33-14%). Overall success for one operator was 23/32 (72%) and two-operator was 24/32 (75%), with mean difference in proportion of -3% (95% CI -24-18). The median number of attempts for one-operator was 1.6 (interquartile range [IQR] 1-5) and two-operator was 1.4 (IQR 1-5) (p=0.8). Time to cannulation for one-operator was 57 s (+/-62) and two-operator was 44 s (+/-37) (p=0.33). The median score for ease-of-technique for one-operator was 4.3 (IQR 1-6) and for two-operator was 3.6 (IQR 1-6) (p=0.26). There were no complications with either technique (95% CI 0-10%). Novice operators can reliably perform a basilic vein cannulation using ultrasound guidance. However, we were unable to demonstrate any advantage for any particular technique in cannulating the basilic vein.
authors.affiliation: Department of Emergency Medicine, University of California, Davis, Sacramento, California 95817, USA.
authors.forename: John S
authors.initials: JS
authors.lastname: Rose
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Norbutas
mesh_terms: D000328:Adult; D001132:Arm / Q000098:blood supply* / Q000000981:diagnostic imaging*; D002406:Catheterization, Peripheral / Q000379:methods*; D016001:Confidence Intervals; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D018084:Ultrasonography, Interventional; D014680:Veins / Q000000981:diagnostic imaging / Q000601:surgery