Department of Emergency Medicine, Boston Medical Center, Boston, MA 02118, USA.
Am J Emerg Med. 2010 Jan;28(1):1-7. doi: 10.1016/j.ajem.2008.09.001.
We determined the survival and complications of ultrasonography-guided peripheral intravenous (IV) catheters in emergency department (ED) patients with difficult peripheral access.
This was a prospective, observational study conducted in an academic hospital from April to July of 2007. We included consecutive adult ED patients with difficult access who had ultrasonography-guided peripheral IVs placed. Operators completed data sheets and researchers examined admitted patients daily to assess outcomes. The primary outcome was IV survival >96 hours. As a secondary outcome, we recorded IV complications, including central line placement. We used descriptive statistics, univariate survival analysis with Kaplan Meier, and log-rank tests for data analysis.
Seventy-five patients were enrolled. The average age was 52 years. Fifty-three percent were male, 21% obese, and 13% had a history of injection drug use. The overall IV survival rate was 56% (95% confidence interval, 44%-67%) with a median survival of 26 hours (interquartile range [IQR], 8-61). Forty-seven percent of IVs failed within 24 hours, most commonly due to infiltration. Although 47 (63%) operators reported that a central line would have been required if peripheral access was unobtainable, only 5 (7%; 95% confidence interval, 2%-15%) patients underwent central venous catheterization. Only 1 central line was placed as a result of ultrasonography-guided IV failure. We observed no infectious or thrombotic complications.
Despite a high premature failure rate, ultrasonography-guided peripheral IVs appear to be an effective alternative to central line placement in ED patients with difficult access.
我们旨在确定在急诊（ED）中，对外周血管穿刺困难的患者行超声引导下外周静脉置管的生存情况和并发症。
这是一项在 2007 年 4 月至 7 月间，于一所学术医院进行的前瞻性、观察性研究。我们纳入了连续的外周血管穿刺困难的成年 ED 患者，对其行超声引导下外周静脉置管。操作者完成数据表，研究者每日对住院患者进行检查，以评估结果。主要结局为外周静脉导管留置时间超过 96 小时。次要结局为记录外周静脉置管并发症，包括中心静脉置管。我们使用描述性统计、Kaplan-Meier 单变量生存分析和对数秩检验进行数据分析。
共纳入 75 例患者，平均年龄为 52 岁，53%为男性，21%为肥胖患者，13%有注射吸毒史。总的外周静脉置管存活率为 56%（95%置信区间，44%-67%），中位生存时间为 26 小时（四分位距[IQR]，8-61）。47%的静脉置管在 24 小时内失效，最常见的原因为渗漏。尽管 47 名（63%）操作者报告，如果外周血管穿刺不成功，将会需要中心静脉置管，但仅有 5 名（7%；95%置信区间，2%-15%）患者接受了中心静脉置管。仅 1 例因超声引导下外周静脉置管失败而进行中心静脉置管。我们未观察到感染或血栓形成并发症。
尽管外周静脉置管的早期失败率较高，但对于外周血管穿刺困难的 ED 患者，超声引导下外周静脉置管似乎是中心静脉置管的有效替代方法。
