Jin Lisa M, Medeck Sarah, Ruley James, Riddle Mark, Aden James
Department of Emergency Medicine, Carl R. Darnall Army Medical Center, 36065 Santa Fe Ave, Fort Hood, TX.
United States Army Institute of Surgical Research, 3551 Roger Brooke Dr, Fort Sam Houston, TX.
Mil Med. 2018 Nov 1;183(11-12):e730-e734. doi: 10.1093/milmed/usy110.
This study was completed to determine if guidewire catheters improve first-pass success and time of placement for peripheral intravenous access. In the military, 21% of casualties from the battlefield arrive to a medical facility in hemorrhagic shock. The importance of successful and timely intravenous placement is crucial in the initial steps of preventing this condition. Multiple studies and reviews have shown that initial first-pass success rates for pre-hospital intravenous placement have been as low as 40%, and an average success rate of 81% when completed by paramedics or similarly skilled personnel. In an attempt to replicate or improve these rates, we proposed to study placement success rates by active duty military combat medics. We hypothesized that there would be no difference in first-pass success rates when using either a standard or guidewire catheter.
This study was a prospective, randomized, controlled trial with a crossover study design comparing the Accucath 18-gauge guidewire catheter to the standard 18-gauge peripheral intravenous catheter. The study included 93 1st Cavalry Division Army Combat Medics. Participants were voluntarily enrolled and consented on an individual basis. Each participant paired with a partner of their choice and acted as their own control. All supplies were laid out for the participants with the catheters randomly selected for either arm of the patient. The subjects were allowed to choose which catheter they would be tested on first. Times were recorded for only successful attempts.
The guidewire catheter was not proven to have a higher cannulation rate, achieving only a 44% success rate versus 66% in the standard catheter group, as well as averaging 42 seconds longer to obtain successful cannulation versus the standard catheter. Interestingly, it was observed that the greater the time in service, there was an increased success rate with the guidewire catheter that was not noted with the standard catheter.
There was not a statistically significant improvement in the first-pass success rate of intravenous placement with the use of the guidewire catheter when compared with the standard-issue catheter. With these results, we cannot recommend the guidewire catheter to be used in leu of the standard catheter. Further studies might show improvement if subjects are allotted increased practice and familiarity with the new guidewire device.
本研究旨在确定导丝导管是否能提高外周静脉穿刺的首次穿刺成功率和穿刺时间。在军队中，21%的战场伤亡人员在到达医疗设施时已处于失血性休克状态。成功且及时地进行静脉穿刺在预防这种情况的初始步骤中至关重要。多项研究和综述表明，院前静脉穿刺的初始首次穿刺成功率低至40%，而由护理人员或技能相当的人员完成时，平均成功率为81%。为了复制或提高这些成功率，我们提议研究现役军队战斗医护人员的穿刺成功率。我们假设使用标准导管或导丝导管时，首次穿刺成功率没有差异。
本研究是一项前瞻性、随机、对照试验，采用交叉研究设计，将Accucath 18号导丝导管与标准18号外周静脉导管进行比较。该研究纳入了93名第1骑兵师的军队战斗医护人员。参与者自愿报名并逐人签署知情同意书。每个参与者与自己选择的伙伴配对，并作为自己的对照。为参与者摆放好所有用品，导管随机分配给患者的任意一侧手臂。受试者可以选择首先测试哪种导管。仅记录成功尝试的时间。
导丝导管未被证明具有更高的插管率，成功率仅为44%，而标准导管组为66%，并且与标准导管相比，获得成功插管的平均时间长42秒。有趣的是，观察到服役时间越长，导丝导管的成功率越高，而标准导管则未观察到这种情况。
与标准导管相比，使用导丝导管进行静脉穿刺的首次穿刺成功率没有统计学上的显著提高。基于这些结果，我们不建议使用导丝导管替代标准导管。如果让受试者有更多时间练习并熟悉这种新的导丝装置，进一步的研究可能会显示出改善效果。
