title: [Efficacy of Ultrasound-Guided Peripheral Intravenous Access: A Systematic Review and Meta-Analysis].
abstract: BACKGROUND
  Peripheral intravenous access is a common, invasive procedure that is performed in clinical practice. Difficult intravenous access may not only jeopardize patient safety but also increase staff stress, nursing hours, and material costs.
  
  
  OBJECTIVE
  To explore the efficacy of ultrasound-guided peripheral intravenous access in difficult intravenous-access patients and in the two subgroups of adult patients and pediatric patients using systematic review and meta-analysis.
  
  
  METHODS
  Six Chinese and English databases, including the Index to Taiwan Periodical Literature System, Airiti Library, CINAHL, Cochrane Library, PubMed/MEDLINE, and ProQuest, were searched for related articles that were published between the earliest year available and April 2016. The search was limited to studies that used randomized control trials (RCTs) or controlled clinical trials (CCTs) and the associated key words "ultrasound-guided" AND "peripheral intravenous access". The 12 articles that met these criteria were used in the analysis. The Joanna Briggs Institute (JBI) critical appraisal checklist was used to assess methodological quality and RevMan 5.3 software was used to conduct the meta-analysis.
  
  
  RESULTS
  The ultrasound-guided technique was found to improve the success rate of intravenous access significantly (OR = 3.00, p < .0001) and to decrease the number of attempts (MD = -0.61, p = .03) in the overall group of difficult intravenous-access patients. The subgroup analysis found a significantly improved success rate and decreased number of attempts in difficult intravenous-access adult patients and significantly decreased procedural times in difficult intravenous-access pediatric patients.
  
  
  CONCLUSIONS
  The ultrasound-guided technique may improve the efficacy of intravenous access by helping health care professionals visualize the peripheral veins. We suggest that patient characteristics, ultrasound accessibility, and the feasibility of staff training be assessed in order to provide ultrasound guidance that improves the efficacy of intravenous access.
authors.affiliation: MSN, RN, Advanced Practice Nurse, Emergency Department, Chi-Mei Medical Center, and Adjunct Assistant Professor, Department of Nursing, Chang Jung Christian University; and Doctoral Candidate, School of Nursing, Kaohsiung Medical University, Taiwan, ROC. kuochiachi@yahoo.com.tw.
authors.forename: Chia-Chi
authors.initials: CC
authors.lastname: Kuo
authors.affiliation: MSN, RN, Advanced Practice Nurse, Emergency Department, Chi-Mei Medical Center, Taiwan, ROC.
authors.forename: Chen-Yun
authors.initials: CY
authors.lastname: Wu
authors.affiliation: PhD, Associate Research Fellow, Department of Medical Research, Chi-Mei Medical Center, Taiwan, ROC.
authors.forename: I-Jung
authors.initials: IJ
authors.lastname: Feng
authors.affiliation: MD, Visiting Staff, Emergency Department, Chi-Mei Medical Center, Taiwan, ROC.
authors.forename: Wei-Jing
authors.initials: WJ
authors.lastname: Lee
mesh_terms: D002406:Catheterization, Peripheral / Q000379:methods*; D006801:Humans; D007275:Injections, Intravenous; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: difficult venous access; peripheral intravenous access; procedure time; ultrasound guide