Abstract
Introduction
Intravenous cannulation is a common procedure for paramedics. Difficulty is often
encountered and may result in escalation of care to an intensive care paramedic (ICP).
Ultrasound-guided peripheral intravenous access (USGPIVA) is used in-hospital as an
alternative approach. Historically limited to physicians, it is increasingly embraced
by non-physicians, with point of care ultrasound (POCUS) devices more affordable,
portable, and suited to the out of hospital environment.
Objective
To explore the utility of ICP-performed USGPIVA for patients who are predicted to
be difficult according to a difficult intravenous access scoring tool.
Methods
This was a prospective observational pilot study of ICPs who used the adult difficult
intravenous access (A-DIVA) scale to predict difficulty and perform USGPIVA using
a contemporary POCUS device.
Results
For the 32 patients enroled, the overall success rate was 50% of which 87% were successful
on the first attempt. Mean A-DIVA score was 4.1/5, and paradoxically, success improved
with A-DIVA-predicted difficulty.
Conclusion
ICPs can perform USGPIVA with moderate success. The A-DIVA score could be useful for
paramedics to predict difficult cannulation. Future research should focus on increasing
exposure, training time and enhancing feedback to paramedics performing USGPIVA.
Keywords
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References
- Accès veineux périphériques au bloc opératoire: caractéristiques et facteurs prédictifs de difficulté.Ann Fr D'Anesth Et De Réanimation. 2012; 31: 600-604
- The prehospital intravenous access assessment: a prospective study on intravenous access failure and access delay in prehospital emergency medicine.Eur J Emerg Med. 2016; 23: 442-447
Vlaar A.P., Hunt B.J. Improving peripheral intravenous catheter failure rates, 2018.
- Ultrasound-guided peripheral venous catheterization in emergency services.J Emerg Nurs. 2016; 42: 338-343
- Two different techniques of ultrasound-guided peripheral venous catheter placement versus the traditional approach in the pre-hospital emergency setting: a randomized study.Intern Emerg Med. 2020; 15: 303-310
- Single-operator ultrasound-guided intravenous line placement by emergency nurses reduces the need for physician intervention in patients with difficult-to-establish intravenous access.J Emerg Med. 2013; 44: 653-660
- Ultrasound-Guided Peripheral Intravenous Access Program Is Associated With a Marked Reduction in Central Venous Catheter Use in Noncritically Ill Emergency Department Patients.Ann Emerg Med. 2013; 61: 198-203
- Intraosseous vascular access: A review.Trauma. 2012; 14: 195-232
- The Role of Intraosseous Vascular Access in the Out-of-Hospital Environment (Resource Document to NAEMSP Position Statement).Prehosp Emerg Care. 2007; 11: 63-66
- Ultrasound-guided peripheral venous catheterization in emergency services.J Emerg Nurs. 2016; 42: 338-343
- Ultrasound-guided peripheral venous access: a meta-analysis and systematic review.J Vasc Access. 2015; 16: 321-326
- Ultrasound guidance for difficult peripheral venous access: systematic review and meta-analysis.Emerg Med J. 2013; 30: 521-526
- Ultrasound-guidance vs. standard technique in difficult vascular access patients by ED technicians.Am J Emerg Med. 2009; 27: 135-140
- The Modified A-DIVA Scale as a Predictive Tool for Prospective Identification of Adult Patients at Risk of a Difficult Intravenous Access: A Multicenter Validation Study.J Clin Med. 2019; 8
- Development of the A-DIVA Scale: A Clinical Predictive Scale to Identify Difficult Intravenous Access in Adult Patients Based on Clinical Observations.Med (Baltim). 2016; 95 (e3428-e3428)
- Risk factors associated with difficult venous access in adult ED patients.Am J Emerg Med. 2014; 32: 1179-1182
- Two different techniques of ultrasound-guided peripheral venous catheter placement versus the traditional approach in the pre-hospital emergency setting: a randomized study.Intern Emerg Med. 2020; 15: 303-310
- Ultrasound-guided peripheral intravenous line placement: a narrative review of evidence-based best practices.West J Emerg Med. 2017; 18: 1047
- Standard-length catheters vs long catheters in ultrasound-guided peripheral vein cannulation.Am J Emerg Med. 2012; 30: 712-716
- Ultrasonography versus landmark for peripheral intravenous cannulation: a randomized controlled trial.Ann Emerg Med. 2016; 68: 10-18
- ED technicians can successfully place ultrasound-guided intravenous catheters in patients with poor vascular access.Am J Emerg Med. 2011; 29: 496-501
- 276: nurse-operated ultrasound for difficult intravenous access: a randomized trial.Ann Emerg Med. 2009; 54 (S87-S87)
- A randomized controlled trial assessing the use of ultrasound for nurse-performed IV placement in difficult access ED patients.Am J Emerg Med. 2016; 34: 1950-1954
- Handheld ultrasound: overcoming the challenge of difficult peripheral intravenous access in the emergency department.J Ultrasound Med. 2020; 39: 1985-1991
- Paramedic intubation experience is associated with successful tube placement but not cardiac arrest survival.Ann Emerg Med. 2017; 70 (e1): 382-390
- Prospective evaluation of the learning curve for ultrasound-guided peripheral intravenous catheter placement.J Vasc Access. 2016; 17: 366-370
- Peripheral intravenous access using ultrasound guidance: defining the learning curve.J Assoc Vasc Access. 2015; 20: 32-36
- 280: effects of vein width and depth in ultrasound-guided IV insertion.Ann Emerg Med. 2008; 52 (S127-S127)
- A randomized controlled trial comparing one-operator versus two-operator technique in ultrasound-guided basilic vein cannulation.J Emerg Med. 2008; 35: 431-435
- Short-axis versus long-axis approaches for teaching ultrasound-guided vascular access on a new inanimate model.Acad Emerg Med. 2003; 10: 1307-1311
Article info
Publication history
Published online: October 25, 2022
Accepted:
October 8,
2022
Received in revised form:
October 3,
2022
Received:
July 26,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.
