The more difficult the patient is to perfuse, the more useful is ultrasound-guided peripheral intravenous cannulation
The more difficult the patient is to perfuse, the more useful is ultrasound-guided peripheral intravenous cannulation
SOURCE
Tada M, Yamada N, Matsumoto T, Takeda C, Furukawa TA, Watanabe N.
Ultrasound guidance versus landmark method for peripheral venous cannulation in adults.
Cochrane Database of Systematic Reviews 2022, Issue 12. Art. No.: CD013434.
DOI:10.1002/14651858.CD013434.pub2.
CONTEXT
Peripheral intravenous cannulation (PIC) is a common and important procedure for patients requiring a blood test or intravenous (IV) therapies. The landmark method, which relies on touch and visualization of veins on the skin, can be complex and may result in treatment delays, multiple painful punctures, and the need for intraosseous or central lines. The effectiveness of ultrasound guidance for PIC is still unclear.
CLINICAL QUESTIONS
Are ultrasound-guided techniques for PIC in adults both safe and effective when compared to landmark method? Does the efficacy of this technique vary depending on the level of PIC difficulty (difficult, moderate, easy) in patients?
BOTTOM LINE
In difficult participants, ultrasound guidance could increase the success rate on the first attempt (low level of evidence), overall success rate (very low level of evidence), and patient satisfaction (very low level of evidence), but may result in a longer insertion time (low level of evidence). There is no significant difference in the pain experienced by the patient during the procedure (very low level of evidence), nor in the occurrence of complications (low level of evidence).
In moderate participants, ultrasound guidance increases success on the first attempt (moderate level of evidence) and patient satisfaction (very low level of evidence) at the cost of an increase in intravenous canulation time on the first attempt (high level of evidence). There is no evidence to suggest that the patient will experience different levels of pain during the procedure. Additionally, there is moderate evidence to suggest that there will be no difference in the occurrence of complications.
In easy participants, ultrasound guidance reduces success on the first attempt (high level of evidence) and increases the pain felt by the patient during the procedure (moderate level of evidence) as well as the procedure time for first-pass cannulation (high level of evidence). There was no difference in terms of the occurrence of complications (moderate level of evidence).
CAVEATS
The level of evidence in the data is low due to the inconsistent definition of different levels of PIC difficulty in the studies included. This has resulted in heterogeneous results and unreliable interpretation. Future studies should aim to use common definitions.
AUTHORS
N. Cazes
nicolas.cazes@icloud.com
Hôpital d’Instruction des armées Laveran
Service des urgences
13013 Marseille, France
A. Renard
aurelien.renard@smurbmpm.fr
Bataillon de marins-pompiers de Marseille
Groupement santé
F-13233 Marseille, France
K. Magee
kmagee@dal.ca
Dalhousie Department of Emergency Medicine
Halifax, Nova Scotia, Canada
