title: Hand dominance in intravenous drug using patients does not affect peripheral venous access sites identified by ultrasound.
abstract: BACKGROUND
  The peripheral veins in the arms and forearms of patients with a history of intravenous (IV) drug use may be sclerosed, calcified, or collapsed due to damage from previous injections. These patients may consequently require alternative, more invasive types of vascular access including central venous or intraosseous catheters. We investigated the relationship between hand dominance and the presence of patent upper extremity (UE) veins specifically in patients with a history of IV drug-use. We predicted that injection into the non-dominant UE would occur with a higher frequency than the dominant UE, leading to fewer damaged veins in the dominant UE. If hand dominance affects which upper extremity has more patent veins, providers could focus their first vascular access attempt on the dominant upper extremity.
  
  
  METHODS
  Adult patients were approached for enrollment if they provided a history of IV drug use into one of their upper extremities. Each upper extremity was examined with a high frequency linear transducer in 3 areas: the antecubital crease, forearm and the proximal arm. The number of fully compressible veins ≥1.8 mm in diameter was recorded for each location.
  
  
  RESULTS
  The mean vein difference between the numbers of veins in the dominant versus the non-dominant UE was -1.5789. At a .05 significance level, there was insufficient evidence to suggest the number of compressible veins between patients' dominant and non-dominant arms was significantly different (P = .0872.)
  
  
  CONCLUSIONS
  The number of compressible veins visualized with ultrasound was not greater in the dominant upper extremity as expected. Practitioners may gain more information about potential peripheral venous access sites by asking patients their previous injection practice patterns.
authors.affiliation: Mount Sinai Beth Israel, Department of Emergency Medicine, New York, NY.
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Kaban
authors.affiliation: St. Barnabas Hospital, Department of Emergency Medicine, Bronx, NY.
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: Avitabile
authors.affiliation: Mount Sinai St. Luke's Hospital, Mount Sinai West Hospital, Department of Emergency Medicine, New York, NY.
authors.forename: Sebastian D
authors.initials: SD
authors.lastname: Siadecki
authors.affiliation: Mount Sinai St. Luke's Hospital, Mount Sinai West Hospital, Department of Emergency Medicine, New York, NY. Electronic address: turan@joshsaul.com.
authors.forename: Turandot
authors.initials: T
authors.lastname: Saul
mesh_terms: D000328:Adult; D000368:Aged; D002406:Catheterization, Peripheral; D004636:Emergency Service, Hospital; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D034941:Upper Extremity / Q000098:blood supply* / Q000000981:diagnostic imaging*; D014654:Vascular Patency; D059289:Vascular Stiffness; D014680:Veins / Q000000981:diagnostic imaging*