2. St. Luke's University Hospital, 801 Ostrum St, Bethlehem, PA 18015, USA.
2. St. Luke's University Hospital, 801 Ostrum St, Bethlehem, PA 18015, USA.
Am J Emerg Med. 2014 Jul;32(7):761-4. doi: 10.1016/j.ajem.2014.04.020. Epub 2014 Apr 18.
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.
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.
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.
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.
Tourniquet is superior to BP cuff for target vein dilation in ultrasound-guided PIV.
在急诊科，10%的情况下，外周静脉通路（PIV）在两次尝试中都无法获得。通常，使用止血带扩张目标静脉；但最近的研究表明，血压（BP）袖带可以改善扩张，这可能会增加 PIV 的成功率。
我们旨在确定在“困难穿刺”患者中，使用 BP 袖带与止血带相比，是否能提高超声引导下 PIV 的成功率。
这是一项前瞻性、随机、单盲试验。纳入至少有 2 次先前尝试失败的需要 PIV 的成年患者。患者随机分配到止血带或 BP 袖带组以扩张目标静脉。护士通过将 BP 袖带充气至 150mmHg 或在选定的肢体上放置止血带来为 PIV 尝试做准备。将肢体包裹起来，使医生对分配情况保持盲态。然后，医生尝试进行超声引导下的 PIV。失败定义为需要超过 3 次超声引导尝试或 30 分钟，或患者不耐受。如果失败发生，医生会解除盲态；患者可以交叉并重新尝试。
共纳入 38 例患者。止血带组（n = 17）和 BP 袖带组（n = 21）的成功率分别为 82.4%和 47.6%（P =.04）。两组在血管深度、直径或手术时间方面没有差异。BP 袖带组中有 6 例交叉并使用止血带成功获得 PIV。
在超声引导下 PIV 中，止血带优于 BP 袖带用于目标静脉扩张。
