Ultrasound-guided intravenous catheter survival impacted by amount of catheter residing in the vein.

OBJECTIVE: Ultrasound (US)-guided peripheral IVs have a high failure rate. We explore the relationship between the quantity of catheter residing within the vein and the functionality of the catheter over time. METHODS: This was a prospective, observational single-site study. Adult ED patients with US-guided IVs had the catheter visualised under ultrasound post-placement. IV placement time and catheter length residing in the vein was obtained. Exclusions included catheter not visualised, patient discharged from ED unless IV failed, <24 hour hospitalisation unless IV failed or patient self-removed IV.Inpatient follow-up occurred within 24, 48 and 72 hours from the IV placement time. Catheter functionality was noted. If the catheter failed, the time and reason for failure was documented. RESULTS: 113 patients were enrolled; 27 were excluded. Of the 86 study subjects, 29 (33.7%) patients' IVs failed and 57 (66.3%) remained functional. Median time to IV failure was 15.6 hours. 100% of IVs failed when <30% of the catheter was in the vein; 32.4% of IVs failed when 30%-64% of the catheter was in the vein; no IVs failed when ≥65% of the catheter was in the vein (p<0.0002). The HR was 0.71 (95% CI 0.60 to 0.83), and for every 5% increase of catheter in vein, the hazard of the IV failing decreases by 29% (p<0.0001). CONCLUSION: The quantity of catheter residing in the vein is a key predictor of long-term functionality of US-guided IVs and is strongly associated with the hazard of failure within 72 hours. Catheter failure is high when <30% of the catheter resided in the vein. Optimum catheter survival occurs when ≥65% of the catheter is placed in the vein.

Utilization of ultrasound for the evaluation of small bowel obstruction: A systematic review and meta-analysis.

INTRODUCTION: Small bowel obstruction (SBO) is a common presentation to the Emergency Department (ED). While computed tomography (CT) is frequently utilized to confirm the diagnosis, this modality is expensive, exposes patients to radiation, may lead to time delays, and is not universally available. This study aimed to determine the test characteristics of ultrasound for the diagnosis of SBO. METHODS: PubMed, CINAHL, Scopus, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were assessed for prospective trials evaluating the accuracy of ultrasound for the detection of SBO. Data were double extracted into a predefined worksheet and quality analysis was performed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. RESULTS: This systematic review identified 11 studies comprising 1178 total patients. Overall, ultrasound was found to be 92.4% sensitive (95% CI 89.0% to 94.7%) and 96.6% specific (95% CI 88.4% to 99.1%) with a positive likelihood ratio of 27.5 (95% CI 7.7 to 98.4) and a negative likelihood ratio of 0.08 (95% CI 0.06 to 0.11). DISCUSSION: The existing literature suggests that ultrasound is a valuable tool in the diagnosis of SBO with a sensitivity and specificity comparable to that of CT. Ultrasound may save time and radiation exposure, while also allowing for serial examinations of patients to assess for resolution of the SBO. It may be particularly valuable in settings with limited or no access to CT. Future studies should include more studies in the Emergency Department setting, comparison of probe choices, and inclusion of more pediatric patients.

A randomized controlled trial assessing the use of ultrasound for nurse-performed IV placement in difficult access ED patients.

OBJECTIVE: This study analyzed outcomes associated with nurse-performed ultrasound (US)-guided intravenous (IV) placement compared to standard of care (SOC) palpation IV technique on poor vascular access patients. METHODS: This was a randomized, prospective single-site study. Phase 1 involved education/training of a cohort of nurses to perform US-guided IVs. This consisted of a didactic module and hands-on requirement of 10 proctored functional IVs on live subjects. Phase 2 involved patient enrollment. emergency department patients meeting strict criteria of poor access were randomized to US-guided or SOC palpation arm. A functional IV placed by a study nurse was considered successful. Unsuccessful placement implied the study nurse failed, and a rescue IV was attempted. Time to IV placement was the total time required to obtain a functional IV and, if needed, a rescue IV. RESULTS: A total of 124 subjects were enrolled; 63 were randomized to the US-guided arm, and 61 were randomized into the SOC arm; 2 patients were excluded, leaving 59 patients. Success rate was 76% for the US-guided arm and 56% for the SOC arm (P=.02). Compared to the SOC arm, the odds ratio for success for the US-guided arm was 2.52 (95% confidence interval, 1.09-5.92). The mean time to IV placement for the US-guided arm was 15.8 and 20.7 minutes for the SOC arm (P=.75). CONCLUSION: In difficult access patients, nurses were more successful in obtaining IV access using US guidance than palpation SOC technique. Lengthier placement times were observed more frequently when the SOC IV technique was used.