From the Hospital of Figueras, Salut Empordà Foundation. Health, Gender and Aging Research Group, Department of Nursing, University of Girona, Spain.
Health, gender and aging Research Group, Department of Nursing, University of Girona, Spain.
Pain Manag Nurs. 2024 Feb;25(1):e37-e44. doi: 10.1016/j.pmn.2023.07.010. Epub 2023 Aug 24.
While many emergency department (ED) patients need peripheral vascular catheterization, diagnosis and treatment are often delayed by difficult intravenous access (DIVA).
This study of ED patients with DIVA was designed to evaluate ultrasound (US)-guided peripheral intravenous (IV) catheterization, compare it with conventional catheterization, and analyse patient pain and satisfaction regarding catheterization.
Randomized controlled clinical trial.
Adult patients treated in the ED who scored >3 on the Adult-Difficult Venous Catheterization scale were randomly assigned to either US-guided or conventional peripheral IV catheterization. Data were collected from April to December 2016. Study variables were catheter insertion success, number of catheterization attempts, time required to perform the procedure, catheter length and calibre, puncture site, complications, and catheter functioning. Pain and patient satisfaction were also analysed for each group and the full sample.
120 and 138 patients were recruited for the US-guided and conventional peripheral IV catheterization groups, respectively. For the US-guided compared to the conventional procedure, insertion success was greater (91.75% versus 89.9%; p=0.04), the mean (SD) number of attempts was lower (1.29 (0.59) versus 1.81 (1.28); p<0.001), mean (SD) satisfaction was greater (7.59 (2.04) versus 6.69 (2.28); p=0.03), and the mean (SD) required time in minutes was greater (7.89 (7.13) versus 5.1 (3.69); p=0.045). Mean (SD) pain was moderate in both groups (4.6 (2.75) versus 4.33 (2.91) (p=0.32). Logistic regression for the full sample indicated that more attempts and greater pain were both associated with reduced satisfaction, while use of higher-calibre catheters was associated with greater satisfaction.
US-guided compared to conventional peripheral IV catheterization in patients with DIVA was more successful, required fewer attempts, enabled use of longer and higher-calibre catheters, and led to greater patient satisfaction. Patients who underwent US-guided intravenous catheterization reported moderate pain, similar to that reported for the conventional procedure.
US-guided peripheral intravenous catheterization improves ED patient care, as it requires fewer catheterization attempts. It is especially recommended for patients with DIVA.
许多急诊科（ED）患者需要进行外周血管置管，但由于静脉穿刺困难（DIVA），其诊断和治疗常常被延误。
本研究旨在评估超声（US）引导下外周静脉（IV）置管在 ED 中 DIVA 患者中的应用，将其与传统置管方法进行比较，并分析置管过程中患者的疼痛和满意度。
随机对照临床试验。
2016 年 4 月至 12 月，对 ED 中成人难度静脉置管评分>3 分的患者进行随机分组，分别接受 US 引导或传统外周 IV 置管。收集置管成功率、置管尝试次数、操作所需时间、导管长度和口径、穿刺部位、并发症和导管功能等数据。对每组患者及总体样本的疼痛和患者满意度进行分析。
分别有 120 例和 138 例患者被纳入 US 引导和传统外周 IV 置管组。与传统置管相比，US 引导组的置管成功率更高（91.75%比 89.9%，p=0.04），尝试次数更少（1.29（0.59）比 1.81（1.28），p<0.001），平均满意度更高（7.59（2.04）比 6.69（2.28），p=0.03），置管所需时间更长（7.89（7.13）比 5.1（3.69），p=0.045）。两组患者的疼痛程度均为中度（4.6（2.75）比 4.33（2.91），p=0.32）。全样本的逻辑回归分析表明，尝试次数较多和疼痛程度较高与满意度降低相关，而使用较大口径的导管与满意度增加相关。
与 DIVA 患者的传统外周 IV 置管相比，US 引导下外周 IV 置管成功率更高，所需尝试次数更少，可使用更长和更大口径的导管，患者满意度更高。接受 US 引导静脉置管的患者报告的疼痛程度为中度，与传统置管方法相似。
US 引导下外周静脉置管可减少置管尝试次数，改善 ED 患者的护理，尤其适用于 DIVA 患者。
