Abstract
Background
Ten percent of the time, peripheral intravenous access (PIV) is not obtained in 2
attempts in the emergency department. Typically, a tourniquet is used to dilate the
target vein; but recent research showed that a blood pressure (BP) cuff improves dilation,
which may translate to increased PIV success.
Objectives
We sought to determine if there is improved success in obtaining ultrasound-guided
PIV using a BP cuff vs a tourniquet in “difficult stick” patients.
Methods
This is a prospective, randomized, single-blinded trial. Adult patients requiring
PIV with at least 2 prior failed attempts were enrolled. Patients were assigned to
tourniquet or BP cuff for target vein dilation randomly. Nurses prepared the patient
for PIV attempt by either placing a BP cuff inflated to 150 mm Hg or placing a tourniquet
on the chosen extremity. The extremity was draped to blind the physician to assignment.
Physicians then attempted ultrasound-guided PIV. Failures were defined as IVs requiring greater than 3 ultrasound-guided attempts or 30 minutes,
or patient intolerance. If failure occurred, the physician was unblinded; and the
patient could be crossed over and reattempted.
Results
Thirty-eight patients were enrolled. The success rate for the tourniquet group (n
= 17) and BP cuff group (n = 21) was 82.4% and 47.6%, respectively (P = .04). There were no differences between groups for vessel depth, diameter, or procedure
time. Six in the BP cuff group were crossed over and had successful PIV obtained with
tourniquet.
Conclusions
Tourniquet is superior to BP cuff for target vein dilation in ultrasound-guided PIV.
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Article Info
Publication History
Published online: April 18, 2014
Accepted:
April 9,
2014
Received in revised form:
April 8,
2014
Received:
March 4,
2014
Footnotes
☆The authors have no conflicts of interest to report.
☆☆Presentations: American Academy of Emergency Medicine, New York, NY, February 2014.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
