Patients With Difficult Vascular Access.
Conditions
Brief summary
This is a randomized controlled trial comparing the success of US guided peripheral IV placement between single vs dual-operator technique among a convenience sample of patients with moderate or difficult vascular access in a tertiary care Emergency Department.
Detailed description
Gaining intravenous (IV) access is a common and important procedure in the emergency department (ED). IV access is needed to deliver drugs, enable fluid resuscitation and sample blood, and delays in gaining access can lead to patient harm. Ultrasound (US) is a commonly used tool in the ED, and the utility of ultrasound in the placement of IVs in patients with difficult access has been well described. This study aims to further guide the use of this evidence based tool by ED Registered Nurses. The focus will be comparing single-operator technique, in which the same provider manipulates the ultrasound probe while simultaneously placing the IV, to a dual-operator technique whereby a second provider manipulates the probe. Any measured advantage has implications in guiding education and practice, as well as informing future ED policy.
Interventions
PROCEDUREDual Operator Ultrasound Guided IV placement
Second operator holds ultrasound probe.
PROCEDURESingle Operator Ultrasound Guided IV placement
Single operator holds ultrasound probe and places IV.
Sponsors
Sunnybrook Health Sciences Centre
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult (18 years and older) patients predicted to require intravenous cannulas and identified at triage as having moderate or difficult access based on the following criteria: Moderate: peripheral vein is visible or palpable but difficulty is expected based on patient characteristics both clinical and historical. Difficult: No peripheral veins visible or palpable, or two failed attempts by traditional landmarking (LM).
Exclusion criteria
*
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| First Pass Success | Total procedure time (<15 minutes) | The proportion of patients in whom vascular access is obtained on the first attempt with a single skin puncture. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Success | Total procedure time (<15 minutes) | The proportion of patients in whom vascular access is achieved within a maximum of three attempts at US guided placement. |
| Number of Attempts | Total procedure time (<15 minutes) | Total number of individual skin punctures that a patient receives. |
| Time to Canulation | Total procedure time (<15 minutes) | Measured as the time from when the Registered Nurse operator first picks up the ultrasound probe to the time when 'flashback' is seen to confirm placement. |
| Patient Pain Score | Total procedure time (<15 minutes) | To be completed by the patient immediately after the procedure: 10cm visual analogue scale from 'painless' to 'very painful'. |
| Operator Ease of Use Score | Total procedure time (<15 minutes) | To be completed by the Registered Nurse operator immediately after the procedure: 10cm visual analogue scale from 'very easy' to 'very difficult'. |
Contacts
Primary ContactCraig Brick, MD
Backup ContactJordan Chenkin, MD, FRCPC
Outcome results
None listed