• Robert Paterson, Brian Euerle, Alexis Salerno, Taylor Miller, Samantha King, and J David Gatz.
• Department of Emergency Medicine, Atrium Health Wake Forest Baptist Health, Winston-Salem, NC, United States of America.
• Am J Emerg Med. 2024 Sep 1; 83: 202420-24.

IntroductionUltrasound is used for peripheral intravenous (PIV) cannulation in patients with difficult landmark-guided IV access in the Emergency Department. Distal-to-proximal application of an Esmarch bandage on the target limb has been suggested as a method for increasing vein size and ease of cannulation.MethodsThis study was a single-blinded crossover randomized controlled trial comparing basilic vein size under ultrasound with use of an Esmarch bandage in addition to standard IV tourniquet ("tourniquet + Esmarch") compared to use of a standard IV tourniquet alone. Participant discomfort with the tourniquet + Esmarch was also compared to that with standard IV tourniquet alone.ResultsTwenty-two healthy volunteers were used to measure basilic vein size with and without the Esmarch bandage. There was no difference in basilic vein size between the two groups, with a mean diameter of 6.0 ± 1.5 mm in the tourniquet + Esmarch group and 6.0 ± 1.4 mm in the control group, p = 0.89. Discomfort score (from 0 to 10) was different between the groups, with a mean discomfort score of 2.1 in the tourniquet + Esmarch group and 1.1 in the standard IV tourniquet alone group (p < 0.001).ConclusionsThis study showed that the use of an Esmarch bandage does not increase basilic vein size in healthy volunteers but is associated with a mild increase in discomfort.Copyright © 2024 Elsevier Inc. All rights reserved.

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