Ultrasound Research Today is a free monthly online journal that collates and summarizes the latest research about Ultrasound, including details on screening, diagnosis, pregnancy, detection. | ||||||||
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Ultrasonographically guided insertion of a 15-cm catheter into the deep brachial or basilic vein in patients with difficult intravenous access.Mills CN, Liebmann O, Stone MB, Frazee BW Department of Emergency Medicine, Alameda County Medical Center-Highland Hospital, Oakland, CA, USA. cnmills@yahoo.com STUDY OBJECTIVE: Standard length (3 to 5 cm) intravenous catheters in the deep brachial or basilic vein tend to dislodge prematurely. We assess the safety and longevity of a 15-cm catheter inserted in these veins by a novel ultrasonographically guided technique. METHODS: This is a prospective cohort study conducted in an urban teaching emergency department (ED). Adult subjects were enrolled if 2 peripheral intravenous insertion attempts had failed. A 3.2-cm, 18-gauge catheter was first inserted into the deep brachial or basilic vein under ultrasonographic guidance. In a separate step, a wire was inserted through this catheter, and a 15-cm, 16-gauge catheter was placed over the wire and left in place for up to 3 days. Primary outcomes were time to securing access and rate of loss of access. Secondary outcomes included complication rates and subject satisfaction. RESULTS: Twenty-five subjects were enrolled; 23 catheters were successfully placed. Median time required for initial vein cannulation was 3 minutes (interquartile range [IQR] 2 to 7 minutes) and for securing the 15-cm catheter was an additional 4 minutes (IQR 3 to 5 minutes). Median duration of access was 26 hours (IQR 10 to 47 hours). The only complication was early infiltration in 1 subject. All subjects rated satisfaction as 4 or 5 on a 5-point Likert scale. CONCLUSION: We present a promising alternative to central venous catheterization in patients with difficult intravenous access. This technique appears to be fast, safe, and well tolerated by adult patients. Published 18 June 2007 in Ann Emerg Med, 50(1): 68-72.
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