Ultrasound-guided peripheral intravenous catheters insertion in patient with difficult vascular access: Short axis/out-of-plane versus long axis/in-plane, a randomized controlled trial.

Abstract

PURPOSE\nThe aim of this study was to evaluate the rate of successful peripheral cannulation between short-axis and long-axis ultrasound guided techniques.\n\n\nMETHODS\nA single-center, two-arm randomized controlled, intention-to-treat, open-label study was conducted at the Emergency Department, between August and November 2020. Patients requiring a peripheral intravenous catheter insertion and identified as having a difficult intravascular access, were enrolled and followed for up to 96\u2009h.The primary endpoint was the correct placement of the peripheral intravenous catheter. The secondary endpoints were number of venipunctures, intra-procedural pain, local complications, and positive blood return during the follow up.\n\n\nRESULTS\nA total of 283 patients were enrolled: 141 subjects were randomized to the short-axis and 142 to the long-axis group. Success rate was 96.45% (135/141; 95% CI, 91.92%-98.84%) in the short-axis group compared with 92.25% (132/142; 95% CI, 86.56%-96.07%) in the long-axis group (p\u2009=\u20090.126). No significant differences were found in terms of intraprocedural pain and local complications. Higher rate of positive blood return at 72\u2009h [3/17 long-axis, 14/17 short-axis (p\u2009=\u20090.005)] and 96\u2009h [1/10 long-axis, 9/10 short-axis 96\u2009h, (p\u2009=\u20090.022)] was found for the short-axis group.\n\n\nCONCLUSIONS\nNo differences were found between short-axis and long-axis techniques in terms of success rate, intraprocedural pain, and local complications. Despite this, a slightly higher success rate, a lower number of venipunctures, and a higher rate of positive blood return at 72 and 96\u2009h together with an easier ultrasound technique could suggest a short-axis approach.