Yalçınlı Sercan, Karbek Akarca Funda, Can Özge, Uz İlhan, Konakçı Gülbin
Department of Emergency Medicine, Ege University, Izmir, TURKEY.
Department of Internal Medicine Nursing Faculty of Health Sciences, Izmir Demokrasi University, Izmir, TURKEY.
Prehosp Disaster Med. 2022 Feb;37(1):65-70. doi: 10.1017/S1049023X21001217. Epub 2021 Dec 6.
Successful placement of a peripheral intravenous catheter (PIVC) on the first attempt is an important outcome for difficult vascular access (DVA) patients. This study compared standard technique, ultrasonography (USG), and near-infrared light (NIR) in terms of success in the first attempt in patients with DVA.
This was a prospective, randomized controlled study. The study was conducted in a tertiary care hospital. Emergency department patients who describe DVA history, have no visible or palpable veins, and were assessed by the nurse to have a difficult PIVC were included to study. The PIVC procedure was performed on patients by standard, USG, or NIR device techniques. For all approaches, the success of the first attempt was the primary aim. Total procedure time, the total number of attempts, and the need for rescue intervention were secondary aims.
This study evaluated 270 patients. The first attempt success rates for USG, standard, and NIR methods were 78.9%, 62.2%, and 58.9%, respectively. The rate of first attempt success was higher in patients who underwent USG (USG versus standard, P = .014; USG versus NIR, P = .004; standard versus NIR, P = .648). The total median (IQR) procedure time for USG, standard, and NIR methods was 107 (69-228), 72 (47-134), and 82 (61-163) seconds, respectively. The total procedure time was longer in patients undergoing USG (standard versus USG, P <.001; NIR versus USG, P = .035; standard versus NIR, P = .055). The total median (IQR) number of attempts of USG, standard, and NIR methods were 1 (1-1), 1 (1-2), and 1 (1-2), respectively. A difference was found among the groups regarding the total number of attempts (USG versus NIR, P = .015; USG versus standard P = .108; standard versus NIR, P = .307). No difference was found among groups in terms of the need for rescue methods.
It was found that USG increases the success of the first attempt compared with the standard method and NIR in patients with DVA.
对于血管通路困难（DVA）患者而言，首次尝试外周静脉导管（PIVC）置入成功是一项重要的成果。本研究比较了标准技术、超声检查（USG）和近红外光（NIR）在DVA患者首次尝试置入中的成功率。
这是一项前瞻性随机对照研究。研究在一家三级护理医院进行。纳入急诊部门有DVA病史、无可见或可触及静脉且经护士评估PIVC置入困难的患者进行研究。通过标准技术、USG或NIR设备技术对患者进行PIVC操作。对于所有方法，首次尝试成功是主要目标。总操作时间、尝试总数和救援干预需求是次要目标。
本研究评估了270例患者。USG、标准技术和NIR方法的首次尝试成功率分别为78.9%、62.2%和58.9%。接受USG检查的患者首次尝试成功率更高（USG与标准技术相比，P = 0.014；USG与NIR相比，P = 0.004；标准技术与NIR相比，P = 0.648）。USG、标准技术和NIR方法的总中位（IQR）操作时间分别为107（69 - 228）秒、72（47 - 134）秒和82（61 - 163）秒。接受USG检查的患者总操作时间更长（标准技术与USG相比，P < 0.001；NIR与USG相比，P = 0.035；标准技术与NIR相比，P = 0.055）。USG、标准技术和NIR方法的总中位（IQR）尝试次数分别为1（1 - 1）、1（1 - 2）和1（1 - 2）。在尝试总数方面各组存在差异（USG与NIR相比，P = 0.015；USG与标准技术相比，P = 0.108；标准技术与NIR相比，P = 0.307）。在救援方法需求方面各组未发现差异。
研究发现，与标准技术和NIR相比，USG可提高DVA患者首次尝试的成功率。
