title: Ultrasonographically guided peripheral intravenous cannulation in emergency department patients with difficult intravenous access: a randomized trial.
abstract: OBJECTIVE
  We seek to compare ultrasonographically guided peripheral intravenous access to a non-ultrasonographically guided method in a randomized trial of emergency department patients with difficult intravenous access.
  
  
  METHODS
  A prospective cohort of patients with difficult intravenous access was established. Patients were randomized to 2 groups: (1) intravenous access obtained through an ultrasonographically guided technique or (2) intravenous access obtained through non-ultrasonographically guided methods. Outcomes measured were number of attempts after enrollment, time to cannulation from enrollment, and patient satisfaction. Groups were compared with nonparametric analysis.
  
  
  RESULTS
  Fifty-nine patients were randomized. Twenty-eight patients were randomized to the ultrasonography group and 31 to the no ultrasonography group. A median of 2 further intravenous attempts was required in each group before successful cannulation, corresponding to a difference of 0 attempts (95% confidence interval [CI] 0 to 1 attempts). Time to cannulation showed a median of 39 minutes in the ultrasonography group compared with 26 minutes for the no ultrasonography group, giving a median increase of 13 minutes for the ultrasonographically guided group (95% CI -5 to 28 minutes). Patients in the ultrasonography group had a median Likert satisfaction score of 8 compared with 7 for the no ultrasonography group, giving a median increase of 1 on this scale in the ultrasonography group (95% CI 0 to 2).
  
  
  CONCLUSIONS
  Ultrasonographically guided peripheral intravenous cannulation did not decrease the number of attempts or the time to successful catheterization, nor did it improve patient satisfaction compared with the group that did not use ultrasonography. Superiority of ultrasonographically guided peripheral intravenous cannulation is not supported by this study.
authors.affiliation: Emergency Department, University of California, San Francisco, San Francisco, CA 94143, USA.
authors.forename: John
authors.initials: J
authors.lastname: Stein
authors.forename: Brian
authors.initials: B
authors.lastname: George
authors.forename: Gerin
authors.initials: G
authors.lastname: River
authors.forename: Anke
authors.initials: A
authors.lastname: Hebig
authors.forename: Daniel
authors.initials: D
authors.lastname: McDermott
mesh_terms: D000328:Adult; D000368:Aged; D002406:Catheterization, Peripheral / Q000379:methods*; D004635:Emergency Medicine / Q000379:methods*; D005260:Female; D006801:Humans; D007260:Infusion Pumps; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*