Ultrasound-guided versus landmark approach for peripheral intravenous access by critical care nurses: a randomised controlled study

Objective

Establishing a peripheral intravenous catheter (PIVC) after a long intensive care unit (ICU) stay can be a challenge for nurses, as these patients may present vascular access issues. The aim of this study was to compare an ultrasound-guided method (UGM) versus the landmark method (LM) for the placement of a PIVC in ICU patients who no longer require a central intravenous catheter (CIVC).

Design

Randomised, controlled, prospective, open-label, single-centre study.

Setting

Tertiary teaching hospital.

Participants

114 awake patients hospitalised in ICU fulfilling the following criteria: (1) with a central venous catheter that was no longer required, (2) needing a PIVC to replace the central venous catheter and (3) with no apparent or palpable veins on upper limbs after tourniquet placement.

Intervention

Placement of a PIVC using an UGM.

Primary outcome

Number of attempts for the establishment of a PIVC in the upper limbs.

Results

57 patients were respectively included in both the UGM group and LM group. Stasis oedema in the upper limbs was the main cause of poor venous access identified in 80% of patients. Both the number of attempts (2 (1–4), p=0.911) and catheter lifespan ((3 (1–3) days and 3 (2–3) days, p=0.719) were similar between the two groups. Catheters in the UGM group tended to be larger (p=0.059) and be associated with increased extravasation (p=0.094).

Conclusion

In ICU patients who no longer require a CIVC, use of an UGM for the establishment of a PIVC is not associated with a reduction in the number of attempts compared with LM.

Trial registration number

NCT02285712; Results.

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