Poulsen Eva, Aagaard Rasmus, Bisgaard Jannie, Sørensen Heidi T, Juhl-Olsen Peter
Department of Cardiothoracic- and Vascular Surgery, Anesthesia Section, Aarhus University Hospital.
Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Aarhus.
Eur J Emerg Med. 2023 Apr 1;30(2):70-77. doi: 10.1097/MEJ.0000000000000993. Epub 2023 Jan 20.
Identifying patients at risk of difficult intravenous access (DIVA) and increasing the success rates of peripheral intravenous catheterization (PIVC), preferably on the first catheterization attempt, is of clinical importance. The aim of this study was to compare the use of dynamic ultrasound guidance for PIVC with the traditional technique of visualization and palpation in patients with predicted DIVA. A systematic review and meta-analysis comparing ultrasound-guided PIVC with the traditional technique was performed. Data were systematically collected through MEDLINE and EMBASE databases from inception to March 2021. Eligibility criteria included randomized controlled trials performed on patients meeting criteria for difficult catheterization comprising either (a) no palpable or visible veins, (b) previous history of difficult venous catheterization, (c) patient age less than 4 years, (d) suspicion of difficult catheterization by operator, or (e) two or more unsuccessful attempts using the traditional technique before enrollment were included. For all outcomes, a random-effects meta-analysis using the DerSimonian and Laird method was performed. The primary outcome was the first-attempt success rate, and the secondary outcomes were the overall success rate and the number of attempts for successful intravenous catheterization. Bias was assessed using the Revised Cochrane Risk of Bias tool. Seven studies with a total of 994 patients were included. Patients comprised both children and adults and settings included operating rooms, emergency departments, and intensive care units. Ultrasound guidance was associated with a higher first-attempt success rate (OR, 3.07; 95% CI, 1.66-5.65; P < 0.001). For the secondary outcomes, ultrasound guidance was associated with a higher overall success rate (OR, 3.02; 95% CI, 1.04-8.79; P = 0.04); however, this finding did not meet statistical significance in a sensitivity analysis (OR, 2.90; 95% CI, 0.71-11.93; P = 0.14). Ultrasound was not associated with a significantly different number of attempts compared with the traditional technique (difference in means, 0.14; 95% CI, -0.32 to 0.05; P = 0.15). The use of ultrasound guidance resulted in a three-fold increase in odds for the first-attempt success rate in patients with predicted DIVA compared with the traditional technique of PIVC.
识别有静脉穿刺困难风险（DIVA）的患者，并提高外周静脉置管（PIVC）的成功率，最好是在首次置管尝试时成功，具有临床重要性。本研究的目的是比较在预测有DIVA的患者中，动态超声引导下PIVC与传统的可视化和触诊技术的使用情况。进行了一项系统评价和荟萃分析，比较超声引导下的PIVC与传统技术。通过MEDLINE和EMBASE数据库系统收集了从数据库建立到2021年3月的数据。纳入标准包括对符合困难置管标准的患者进行的随机对照试验，这些标准包括：（a）无可触及或可见的静脉；（b）既往有静脉置管困难史；（c）患者年龄小于4岁；（d）操作者怀疑置管困难；或（e）在入组前使用传统技术进行两次或更多次不成功的尝试。对于所有结局，采用DerSimonian和Laird方法进行随机效应荟萃分析。主要结局是首次尝试成功率，次要结局是总体成功率和成功静脉置管的尝试次数。使用修订的Cochrane偏倚风险工具评估偏倚。纳入了7项研究，共994例患者。患者包括儿童和成人，场所包括手术室、急诊科和重症监护病房。超声引导与更高的首次尝试成功率相关（OR，3.07；95%CI，1.66-5.65；P<0.001）。对于次要结局，超声引导与更高的总体成功率相关（OR，3.02；95%CI，1.04-8.79；P=0.04）；然而，这一发现在敏感性分析中未达到统计学显著性（OR，2.90；95%CI，0.71-11.93；P=0.14）。与传统技术相比，超声引导与尝试次数的差异不显著（均值差异，0.14；95%CI，-0.32至0.05；P=0.15）。与传统的PIVC技术相比，在预测有DIVA的患者中，使用超声引导使首次尝试成功率的优势增加了三倍。
