title: Ultrasound-guided peripheral intravenous access program is associated with a marked reduction in central venous catheter use in noncritically ill emergency department patients.
abstract: OBJECTIVE
  We examine the central venous catheter placement rate during the implementation of an ultrasound-guided peripheral intravenous access program.
  
  
  METHODS
  We conducted a time-series analysis of the monthly central venous catheter rate among adult emergency department (ED) patients in an academic urban ED between 2006 and 2011. During this period, emergency medicine residents and ED technicians were trained in ultrasound-guided peripheral intravenous access. We calculated the monthly central venous catheter placement rate overall and compared the central venous catheter reduction rate associated with the ultrasound-guided peripheral intravenous access program between noncritically ill patients and patients admitted to critical care. Patients receiving central venous catheters were classified as noncritically ill if admitted to telemetry or medical/surgical floor or discharged home from the ED.
  
  
  RESULTS
  During the study period, the ED treated a total of 401,532 patients, of whom 1,583 (0.39%) received a central venous catheter. The central venous catheter rate decreased by 80% between 2006 (0.81%) and 2011 (0.16%). The decrease in the rate was significantly greater among noncritically ill patients (mean for telemetry patients 4.4% per month [95% confidence interval {CI} 3.6% to 5.1%], floor patients 4.8% [95% CI 4.2% to 5.3%], and discharged patients 7.6% [95% CI 6.2% to 9.1%]) than critically ill patients (0.9%; 95% CI 0.6% to 1.2%). The proportion of central venous catheters that were placed in critically ill patients increased from 34% in 2006 to 81% in 2011 because fewer central venous catheterizations were performed in noncritically ill patients.
  
  
  CONCLUSIONS
  The ultrasound-guided peripheral intravenous access program was associated with reductions in central venous catheter placement, particularly in noncritically ill patients. Further research is needed to determine the extent to which such access can replace central venous catheter placement in ED patients with difficult vascular access.
authors.affiliation: Department of Emergency Medicine, George Washington University, Washington, DC, USA. hshokoohi@mfa.gwu.edu
authors.forename: Hamid
authors.initials: H
authors.lastname: Shokoohi
authors.forename: Keith
authors.initials: K
authors.lastname: Boniface
authors.forename: Melissa
authors.initials: M
authors.lastname: McCarthy
authors.forename: Tareq
authors.initials: T
authors.lastname: Khedir Al-tiae
authors.forename: Mehdi
authors.initials: M
authors.lastname: Sattarian
authors.forename: Ru
authors.initials: R
authors.lastname: Ding
authors.forename: Yiju Teresa
authors.initials: YT
authors.lastname: Liu
authors.forename: Ali
authors.initials: A
authors.lastname: Pourmand
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Schoenfeld
authors.forename: James
authors.initials: J
authors.lastname: Scott
authors.forename: Robert
authors.initials: R
authors.lastname: Shesser
authors.forename: Kabir
authors.initials: K
authors.lastname: Yadav
mesh_terms: D061605:Administration, Intravenous / Q000379:methods / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data*; D002406:Catheterization, Peripheral / Q000379:methods* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018084:Ultrasonography, Interventional / Q000706:statistics & numerical data*