Emergencies, Overweight and Obesity
Conditions
Keywords
Nurse led, Ultrasound, Emergency department, Overweight, Obesity
Brief summary
Overweight and obesity may be associated with difficult intravenous access leading to longer procedure time and more placement attempts of peripheral venous catheters (PVC). Dynamic ultrasound-guided short-axis needle tip navigation (DUST) may facilitate the procedure. This was a prospective, randomized, non-blinded study to compare time and placement attempts for nurse-led standard (ST) and ultrasound guided PVC placement in 90 emergency patients with a BMI ≥25kg/m2. Consenting patients were randomized at a 1:1 ratio to receive PVC by either ST or DUST. Application time was defined as the time from applying stasis to visible blood in the PVC flash-chamber. No difference in time was found (medians: ST 42 s; DUST 53.5 s, P = 0.535). There were on average 17 % less placement attempts in the DUST-group (median 1 attempt; Q1 = 1 Q3 = 1) compared to the ST-group (median 1 attempt; Q1 = 1 Q3 = 1.5), (p = 0.031). Patients reported no differences in perceived pain (p = 0.955) or perceived satisfaction (p = 0.342). Pain and subcutaneous infiltrations were the only side-effects reported (ST-group 6, DUST-group 5). DUST does not decrease time to functional PVC but reduces the number of PVC placement attempts in patients with BMI ≥25 kg/m2.
Interventions
DEVICEDynamic ultrasound-guided short-axis needle tip navigation
placement of peripheral venous catheters using ultrasound guided technique
OTHERStandard technique of placing a PVC
Standard technique with palpation or Visual inspection of the pvc placement site
Sponsors
University Hospital, Linkoeping
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
* REETS prioritization level of Orange, Yellow, Green or Blue * 18 years old * BMI ≥25 Kg/m2 * Need of PVC according to Emergency department guidelines * Able to give written informed consent
Exclusion criteria
* Unable or unwilling to provide informed consent * Life threatening patient status (REETS prioritization level of Red) * Immunosuppression * Pregnant or lactating women * Blood infections * Puncture zone skin damaged (burns, eczema, infection)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of cannulation attempts | 1 hour | The total number of cannulation attempts performed per patient |
| Time to application | 1 hour | Application time was defined as the time from applying stasis to visible blood in the PVC flash-chamber. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patient satisfaction | 1 hour | The perceived satisfaction of the patient as indicated by Numeric Rating scale (NRS, 0 = not satisfied, 10 = maximum satisfaction) |
| Perceived Pain | 1 hour | The perceived pain of the patient as indicated by Numeric Rating scale (NRS, 0 = no pain, 10 = the worst pain possible) |
Countries
Sweden
Outcome results
None listed