Department of Emergency Medicine, University of Saskatchewan, 2646 Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada.
Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States of America.
Am J Emerg Med. 2020 Jan;38(1):122-126. doi: 10.1016/j.ajem.2019.07.022. Epub 2019 Jul 17.
The 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).
This 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.
Seventy 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).
In 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.
本初步研究旨在探究在急诊科（ED）中，对于静脉穿刺困难的患者，使用导丝是否能提高超声引导下外周静脉置管（PIV）的成功率。
这是一项由单一学术 ED 的急诊医学（EM）临床医生进行的非盲、前瞻性、随机试验。合格的参与者被随机分为两组，分别进行超声引导下 PIV 置管，一组使用导丝，一组不使用导丝。使用 Accucath™ 20 号×5.7cm 导管，通过导丝的部署或不部署来进行 PIV 置管。主要观察指标为首次穿刺成功率，次要观察指标包括穿刺次数、并发症发生率和临床医生报告的插入难易程度。
共纳入 70 名患者，最终 69 名患者纳入最终分析。34 名参与者被随机分为使用导丝组，35 名参与者被随机分为不使用导丝组。使用导丝和不使用导丝的首次穿刺成功率相似，分别为 47.1%和 45.7%（p=0.9）。两种技术的中位数穿刺次数无差异，分别为 2（IQR 1-2）和 2（IQR 1-2）（p=0.60）。并发症发生率也相似，分别为 15%和 29%（p=0.25）。临床医生在 5 分制 Likert 量表上报告的两种方法的插入难易程度无差异，平均值分别为 2.6 和 2.7（p=0.76）。
在这项比较 ED 患者使用集成导丝与不使用导丝进行超声引导下 PIV 置管的初步研究中，首次穿刺成功率、穿刺次数或并发症发生率均无显著差异。本研究为进一步研究提供了初步数据。
