UltraSound guided PEripheral Catheterization increases first-atTempt success RAte in hospitalized patients when compared with conventional technique: SPECTRA

Abstract

Background:

Peripheral intravenous catheter (PIVC) insertion is the most common invasive procedure in the hospital setting. Ultrasound guided PIVC insertion in specific populations and settings has shown patient care benefits.

Objective:

To compare the success rate of first attempts of ultrasound guided PIVC insertion performed by nurse specialists with conventional PIVC insertion performed by nurse assistants.

Method:

Randomized, controlled, single-center clinical trial registered on the ClinicalTrials.gov platform under registration NTC04853264, conducted at a public university hospital from June to September 2021. Adult patients hospitalized in clinical inpatient units with an indication for intravenous therapy compatible with a peripheral venous network were included. Participants in the intervention group (IG) received ultrasound guided PIVC performed by nurse specialists from the vascular access team, while those in the control group (CG) received conventional PIVC by nurse assistants.

Results:

The study included a total of 166 patients: IG (n = 82) and CG (n = 84), mean age 59.5 ± 16.5 years, mostly women (n = 104, 62.7%) and white (n = 136, 81.9%). Success rate on the first attempt of PIVC insertion in IG was 90.2% and in CG was 35.7% (p < 0.001), with a relative risk of 2.5 (95% CI 1.88–3.40) for success in IG versus CG. Overall assertiveness rate was 100% in IG and 71.4% in CG. Regarding procedure performance time, the medians in IG and CG were 5 (4–7) and 10 (6–27.5) min respectively (p < 0.001). As for the incidence of negative composite outcomes, IG had lower rates compared to CG, 39% versus 66.7% (p < 0.001), generating a 42% lower probability of negative outcomes in IG, 0.58 (95% CI: 0.43–0.80).

Conclusion(s):

Successful first-try insertion was higher in the group receiving ultrasound-guided PIVC. Moreover, there were no insertion failures and IG presented lower insertion time rates and incidence of unfavorable outcomes.

Keywords

Advanced practice nursing ultrasound peripheral catheterization clinical trial

Get full access to this article

View all access options for this article.

References

Alexandrou

Ray-Barruel

Carr

, et al. Use of short peripheral intravenous catheters: characteristics, management, and Outcomes Worldwide. J Hosp Med 2018; 13(5): E1–E7.

Keogh

Mathew

. Peripheral intravenous catheters: a review of guidelines and research. Sydney: ACSQHC, 2019.

Bridey

Thilly

Lefevre

, et al. Ultrasound-guided versus landmark approach for peripheral intravenous access by critical care nurses: a randomised controlled study. BMJ Open 2018; 8: e020220–e020228.

Moureau

. Vessel health and preservation: the right approach for vascular access. Cham: Springer, 2019.

Gorski

Hadaway

Hagle

, et al. Infusion therapy standards of practice, 8th edition. J Infus Nurs 2021; 44(1S): S1–S224.

Cochrane

Henwood

Platz

, et al. A randomized trial of ultrasound-guided peripheral IV catheter placement in difficult access patients using a guidewire approach. Am J Emerg Med 2020; 38(1): 122–126.

Australian Commission on Safety and Quality in Health Care. Management of peripheral intravenous catheters clinical care standard. Sydney: ACSQHC, 2021.

Millington

Hendin

Shiloh

, et al. Better with ultrasound: peripheral intravenous catheter insertion. Chest 2020; 157(2): 369–375.

Tada

Yamada

Matsumoto

, et al. Ultrasound guidance versus landmark method for peripheral venous cannulation in adults. Cochrane Database Syst Rev 2022; 12(12): CD013434.

10.

Tran

Fairchild

Yardi

, et al. Efficacy of ultrasound-guided peripheral intravenous cannulation versus standard of care: A systematic review and meta-analysis. Ultrasound Med Biol 2021; 47: 3068–3078.

11.

Costantino

Parikh

Satz

, et al. Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access. Ann Emerg Med 2005; 46: 456–461.

12.

Egan

Healy

O’Neill

, et al. Ultrasound guidance for difficult peripheral venous access: systematic review and meta-analysis. Am J Emerg Med 2013; 30(7): 521–526.

13.

Bahl

Pandurangadu

Tucker

, et al. A randomized controlled trial assessing the use of ultrasound for nurse-performed IV placement in difficult access ED patients. Am J Emerg Med 2016; 34: 1950–1954.

14.

. Comparison of ultrasound guided and conventional techniques for peripheral venous catheter insertion in pediatric patients: a systematic review and meta-analysis of randomized controlled trials. Front Pediatr 2021; 9: 797705.

15.

Nishizawa

Matsumoto

Todaka

, et al. Nurse-performed ultrasound-guided technique for difficult peripheral intravenous access in critically ill patients: a randomized controlled trial. J Assoc Vasc Access 2020; 25(2): 34–39.

16.

Turner

Shamseer

Altman

, et al. Consolidated standards of reporting trials (CONSORT) and the completeness of reporting of randomised controlled trials (RCTs) published in medical journals. Cochrane Database Syst Rev 2012; 11: MR000030.

17.

Vinograd

Chen

Woodford

, et al. Ultrasonographic guidance to improve first-attempt success in children with predicted difficult intravenous access in the emergency department: a randomized controlled trial. Ann Emerg Med 2019; 74(1): 19–27.

18.

Hospital de Clínicas de Porto Alegre. Principais Números, https://www.hcpa.edu.br/ (2020). Accessed date: June 20, 2022.

19.

Dat

, et al. Prevalence of and factors associated with difficult peripheral venipuncture in adult surgical patients. J Vasc Access 2021; 22(3): 404–410.

20.

Charlson

Pompei

Ales

, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40(5): 373–383.

21.

van Loon

FHJ

van Hooff

LWE

de Boer

, et al. The modified A-DIVA scale as a predictive tool for prospective identification of adult patients at risk of a difficult intravenous access: a multicenter validation study. J Clin Med 2019; 8(2): 144.

22.

Marsh

Webster

Larson

, et al. Observational study of peripheral intravenous catheter outcomes in adult hospitalized patients: a multivariable analysis of peripheral intravenous catheter failure. J Hosp Med 2018; 13(2): 83–89.

23.

Vendramim

Avelar

AFM

Rickard

, et al. The RESPECT trial–Replacement of peripheral intravenous catheters according to clinical reasons or every 96 hours: a randomized, controlled, non-inferiority trial. Int J Nurs Stud 2020; 107: 103504.

24.

Webster

Osborne

Rickard

, et al. Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database Syst Rev 2019; 1(1): CD007798.

25.

Harris

Taylor

Minor

, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform 2019; 95: 103208.

26.

van Loon

FHJ

Buise

Claassen

JJF

, et al. Comparison of ultrasound guidance with palpation and direct visualisation for peripheral vein cannulation in adult patients: a systematic review and meta-analysis. Br J Anaesth 2018; 121(2): 358–366.

27.

Foor

Moureau

Gibbons

, et al. Investigative study of hemodilution ratio: 4Vs for vein diameter, valve, velocity, and volumetric blood flow as factors for optimal forearm vein selection for intravenous infusion. J Vasc Access 2022; 1(9): 11297298221095287.

28.

Duran-Gehring

Bryant

Reynolds

, et al. Ultrasound-guided peripheral intravenous catheter training results in physician-level success for emergency department technicians. J Ultrasound Med 2016; 35(11): 2343–2352.

29.