Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Emergency Medicine, Mayo Clinic Health System - Southwest Minnesota region, Mankato, Minnesota.
J Emerg Med. 2022 Feb;62(2):191-199. doi: 10.1016/j.jemermed.2021.10.006. Epub 2022 Jan 5.
Early recognition of difficult intravenous (i.v.) access and use of ultrasound-guided techniques prior to multiple attempts are important steps in improving patient care in the emergency department (ED). Success rates for ultrasound-guided peripheral i.v. (PIV) cannulation are affected by depth, size of target vessel, and predictability of anatomy. The great saphenous vein (GSV) in the medial distal thigh may provide an alternative site for ultrasound-guided cannulation in cases of difficult peripheral venous access.
Our objective was to determine the feasibility of ultrasound-guided GSV PIV placement as an alternative site for patients with difficult i.v. access.
Participants were prospectively enrolled from a convenience sample of patients presenting to the ED in June and July 2019. Inclusion criteria were age 18 years and older, and a history of difficult i.v. access or two unsuccessful nursing staff attempts. Ultrasound-guided access was conducted with an in-plane or out-of-plane approach on the basis of proceduralist preference.
Twenty patients were enrolled; 1 patient withdrew consent prior to cannulation. GSV cannulation was successful in 14 (73.7%) of the 19 patients. Phlebotomy, blood transfusion, i.v. medications including norepinephrine, and i.v. computed tomography contrast medium were successfully performed via GSV access. No reported infection, thrombosis, or extravasation was identified throughout the cannulation dwell time, hospitalization, or for 72 h after discharge.
Ultrasound-guided GSV PIV placement is a feasible alternative in situations of difficult i.v. access. No unforeseen complication or safety issue was identified. Blood products, medications, and contrast medium were successfully administered safely.
在多次尝试之前，早期识别困难的静脉（IV）通路并使用超声引导技术是改善急诊科（ED）患者护理的重要步骤。超声引导下外周静脉（PIV）置管的成功率受深度、目标血管大小和解剖结构的可预测性的影响。大腿内侧远端的大隐静脉（GSV）可能为困难外周静脉通路的患者提供超声引导下置管的替代部位。
我们的目的是确定超声引导下 GSV PIV 置管作为困难 IV 通路患者替代部位的可行性。
参与者是 2019 年 6 月至 7 月从 ED 就诊的便利样本中前瞻性招募的。纳入标准为年龄 18 岁及以上，且有困难 IV 通路史或两次不成功的护理人员尝试。超声引导下的通路是根据程序专家的偏好进行平面内或平面外方法。
共纳入 20 例患者；1 例患者在置管前撤回同意。19 例患者中有 14 例（73.7%）GSV 置管成功。通过 GSV 通路成功进行了采血、输血、静脉注射药物（包括去甲肾上腺素）和静脉注射 CT 造影剂。在整个置管停留时间、住院期间或出院后 72 小时内，均未报告感染、血栓形成或外渗。
在困难 IV 通路的情况下，超声引导下 GSV PIV 置管是一种可行的替代方法。未发现意外并发症或安全问题。成功安全地输注了血液制品、药物和造影剂。
