Randomized trial of tourniquet vs blood pressure cuff for target vein dilation in ultrasound-guided peripheral intravenous access - 20/06/14
Abstract |
Background |
Ten percent of the time, peripheral intravenous access (PIV) is not obtained in 2 attempts in the emergency department. Typically, a tourniquet is used to dilate the target vein; but recent research showed that a blood pressure (BP) cuff improves dilation, which may translate to increased PIV success.
Objectives |
We sought to determine if there is improved success in obtaining ultrasound-guided PIV using a BP cuff vs a tourniquet in “difficult stick” patients.
Methods |
This is a prospective, randomized, single-blinded trial. Adult patients requiring PIV with at least 2 prior failed attempts were enrolled. Patients were assigned to tourniquet or BP cuff for target vein dilation randomly. Nurses prepared the patient for PIV attempt by either placing a BP cuff inflated to 150 mm Hg or placing a tourniquet on the chosen extremity. The extremity was draped to blind the physician to assignment. Physicians then attempted ultrasound-guided PIV. Failures were defined as IVs requiring greater than 3 ultrasound-guided attempts or 30 minutes, or patient intolerance. If failure occurred, the physician was unblinded; and the patient could be crossed over and reattempted.
Results |
Thirty-eight patients were enrolled. The success rate for the tourniquet group (n = 17) and BP cuff group (n = 21) was 82.4% and 47.6%, respectively (P = .04). There were no differences between groups for vessel depth, diameter, or procedure time. Six in the BP cuff group were crossed over and had successful PIV obtained with tourniquet.
Conclusions |
Tourniquet is superior to BP cuff for target vein dilation in ultrasound-guided PIV.
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☆ | The authors have no conflicts of interest to report. |
☆☆ | Presentations: American Academy of Emergency Medicine, New York, NY, February 2014. |
Vol 32 - N° 7
P. 761-764 - juillet 2014 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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