• Am J Emerg Med · Jan 2020

    Randomized Controlled Trial

    A randomized trial of ultrasound-guided peripheral IV catheter placement in difficult access patients using a guidewire approach.

    • Haley K Cochrane, Patricia C Henwood, Elke Platz, Viktoria Koskenoja, Adaira Landry, Sarah E Frasure, Joshua S Rempell, Janet Hoyler, Olesya Baker, and Heidi H Kimberly.
    • Department of Emergency Medicine, University of Saskatchewan, 2646 Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada. Electronic address: hkc445@mail.usask.ca.
    • Am J Emerg Med. 2020 Jan 1; 38 (1): 122-126.

    ObjectiveThe purpose of this pilot study was to investigate whether use of a guidewire improves successful placement of ultrasound-guided peripheral IVs (PIV) in difficult intravenous access patients in the emergency department (ED).MethodsThis was an unblinded, prospective, randomized trial performed by emergency medicine (EM) clinicians at a single academic ED. Eligible participants were randomized to ultrasound-guided PIV placement with or without the use of a guidewire. PIV access was obtained using the Accucath™ 20 gauge × 5.7 cm catheters by way of deployment or non-deployment of the guidewire. Primary outcome measure was first-pass success rate and secondary outcomes included number of attempts, complication rates, and clinician reported ease of insertion.ResultsSeventy patients were enrolled and 69 were included in the final analysis. Thirty-four participants were randomized to use of guidewire and 35 to no guidewire. First-pass success rates were similar with and without guidewire use, 47.1% vs. 45.7%, (p = 0.9). There were no differences found in median number of attempts between the two techniques, 2 (IQR 1-2) vs 2 (IQR 1-2), (p = 0.60). The complication rates were similar, 15% vs. 29% (p = 0.25). Clinicians reported no difference in ease of insertion between methods on a 5-point Likert Scale, mean 2.6 vs 2.7 (p = 0.76).DiscussionIn this pilot study comparing ultrasound-guided PIV placement in ED patients using an integrated guidewire versus no guidewire, there was no significant difference in first-pass success, number of attempts, or complication rates. This study provides preliminary data for further investigations.Copyright © 2019 Elsevier Inc. All rights reserved.

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