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Figures
Fig. 1
Box plot of time required to catheter positioning. The central line represents the median value, the box boundaries represent the 25th and 75th percentiles, and the whiskers represent the minimum and the maximum values. Procedure time was significantly shorter in patients randomized to SC (P = .001).
Fig. 2
Kaplan-Meier survival probability comparing patients with SC to those who received LC. The curves are significantly different (log-rank test; P = .000165).
Abstract
Purpose
Ultrasound (US) is a useful tool for peripheral vein cannulation in patients with difficult venous access. However, few data about the survival of US-guided peripheral catheters in acute care setting exist. Some studies showed that the survival rate of standard-length catheters (SC) is poor especially in obese patients. The use of longer than normal catheters could provide a solution to low survival rate. The aim of the present study was to compare US-guided peripheral SCs vs US-guided peripheral long catheters inserted with Seldinger technique (LC) in acute hospitalized patients with difficult venous access.
Methods
This was a prospective, randomized controlled trial. A total of 100 consecutively admitted subjects in an urban High Dependency Unit were randomized to obtain US-guided intravenous access using either SC or LC after 3 failed blind attempts. Primary outcome was catheter failure rate.
Results
Success rate was 86% in the SC groups and 84% in the LC group (P = .77). Time requested to positioning venous access resulted to be shorter for SC as opposed to LC (9.5 vs 16.8 minutes, respectively; P = .001). Catheter failure was observed in 45% of patients in the SC group and in 14% of patients in the LC group (relative risk, 3.2; P < .001).
Conclusions
Both SC and LC US-guided cannulations have a high success rate in patients with difficult venous access. Notwithstanding a higher time to cannulation, LC US-guided procedure is associated with a lower risk of catheter failure compared with SC US-guided procedure.
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