Advanced intravenous access: technique choices, pain scores, and failure rates in a local registry

The American Journal of Emergency Medicine
M D WittingCheryll B Mack

Abstract

When an intravenous (IV) catheter is needed and the common approach of inspection and palpation fails, an advanced access technique becomes necessary. Our objectives were to estimate pain scores, operator times, success rates, and complication rates when advanced techniques are used in a clinical setting. We enrolled patients who had a need for advanced IV access and were able to give informed consent to participate in our study. We collected data on operator type, technique, initial success, number of attempts, skin punctures, operator time, pain scores, and complications. We estimated confidence intervals for proportions using normal binomial approximation or exact calculation. The registry documented 154 attempts in 116 patients. The median time from triage to establishment of an IV line was 203 minutes; multiple advanced attempts were required in 24% of cases. Most attempts (95%) used either ultrasound-guided cannulation of a peripheral vein (PUG) (108) or cannulated the external jugular vein (EJ) (38). These 2 methods yielded similar pain scores (4.3-4.5), but PUG required more skin punctures (1.6 vs 1.2) and longer operator time (17.7 vs 11.9 minutes). The only complication was IV line failure, occurring in 6% (95% confid...Continue Reading

References

Dec 4, 2004·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Larry BrannamMichael Flake
Apr 26, 2011·Journal of Emergency Nursing : JEN : Official Publication of the Emergency Department Nurses Association·Gayla MilesDave Spear
Sep 29, 2011·Annals of Emergency Medicine·UNKNOWN American College of Emergency Physicians
Jul 17, 2012·The American Journal of Emergency Medicine·Arthur K AuJ Matthew Fields
Sep 10, 2014·The Journal of Vascular Access·J Matthew FieldsBon S Ku

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Citations

Sep 24, 2016·The Journal of Emergency Medicine·Siamak MoayediMatthew Pirotte
Oct 22, 2016·The Journal of Emergency Medicine·Michael D WittingBrad M Cogan
Mar 19, 2020·Journal of Clinical Medicine·Miguel Angel Rodriguez-CaleroJosé Miguel Morales-Asencio
Jul 29, 2020·The Journal of Vascular Access·Monteiro DatToffano Sem

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