title: Ultrasound-guided peripheral intravenous access in the emergency department using a modified Seldinger technique.
abstract: BACKGROUND
  The utility of ultrasound-guided peripheral intravenous access (USGPIV) has been well described. However, few studies have investigated USGPIV techniques.
  
  
  OBJECTIVE
  To describe a modified Seldinger technique for USGPIV.
  
  
  METHODS
  Emergency Department patients with difficult i.v. access (three or more failed landmark attempts) were prospectively enrolled. USGPIV was attempted using modified Seldinger technique. A 20-gauge, 3.81-cm catheter with integral wire was used for all procedures. The basilic vein was identified using a high-frequency linear probe (5-10 MHz). The needle was inserted into the vein with dynamic guidance in short axis, and the cannula was advanced over a wire. Time from skin puncture to catheter insertion, number of needle sticks, and overall procedure time were recorded.
  
  
  RESULTS
  Twenty-five patients were enrolled and underwent USGPIV; success rate was 96% (24/25). The mean number of needle sticks was 1.32 (95% confidence interval 1.12-1.52). Median time from skin to catheter insertion was 68 s (+/- SD 70.5 s). Median total procedure time was 7 min (420 s) (+/- SD 5.23 min).
  
  
  CONCLUSIONS
  Modified Seldinger technique is an effective method of USGPIV and is worthy of a prospective comparison with non-Seldinger technique.
authors.affiliation: Department of Emergency Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71130, USA.
authors.forename: Simon A
authors.initials: SA
authors.lastname: Mahler
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.forename: Chad
authors.initials: C
authors.lastname: Lester
authors.forename: Steven A
authors.initials: SA
authors.lastname: Conrad
mesh_terms: D000328:Adult; D002406:Catheterization, Peripheral / Q000295:instrumentation / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D011446:Prospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods*