Two different techniques of ultrasound-guided peripheral venous catheter placement versus the traditional approach in the pre-hospital emergency setting: a randomized study
We performed a randomized pre-hospital clinical study to compare two different techniques of ultrasound-guided peripheral venous catheter (PVC) insertion and the conventional cannulation technique in the pre-hospital emergency setting, with a specific focus on the procedural success rate and the time required to introduce PVC. This pre-hospital prospective controlled randomized clinical trial allocated patients treated by emergency medical service to undergo PVC insertion fully controlled by ultrasound (ultrasound guidance of the PVC tip until it penetrates the lumen, group A), PVC insertion partially controlled by ultrasound (target vein identification only, group B) or to receive PVC without any ultrasound guidance (group C). The study outcomes were monitored until the patient was admitted to the hospital. A total of 300 adult patients were enrolled. The success of the first attempt (group A: 88%, group B: 94%, group C: 76%, p < 0.001) and overall success rate (A: 99%, B: 99%, C: 90%, p < 0.001) were significantly higher in the group A, followed by group B when compared to group C. The number of attempts was significantly lower (A: 1.18 ± 0.54, B: 1.05 ± 0.22, C: 1.22 ± 0.57, p < 0.001) and the time required for the procedure shorter (A: 75.3 ± 60.6, B: 43.5 ± 26.0, C: 82.3 ± 100.9 s, p < 0.001) in group B compared to groups A and C. Both techniques of ultrasound-guided PVC placement were associated with higher success rates than the conventional method. However, PVC insertion partially controlled by ultrasound was superior to full ultrasound guidance in terms of time and number of cannulation attempts required.
KeywordsUltrasound Peripheral venous catheter Pre-hospital care
We would like to cordially thank all patients and all investigators for participating in the study. We acknowledge the statistical support of Ondrej Bradac, MD, PhD.
RS conceived the study, designed the trial, supervised the trial and data collection, undertook recruitment of the patients, provided statistical analysis, prepared the manuscript and takes responsibility for the paper as a whole. JC and PV designed the trial, supervised the trial, undertook recruitment of the patients and contributed substantially to the manuscript preparation. The role of VC was the senior researcher, he designed the trial, provided quality control and contributed substantially to the data analysis and the manuscript preparation.
Authors declare no financial funding.
Compliance with ethical standards
Conflict of interest
Skulec R reports no financial support from GE Medical Systems Ceska republika, s.r.o.; two ultrasound devices, Vscan Dual Probe (GE Healthcare, Chicago, Illinois, USA), were temporarily provided by them for study purposes. Otherwise, he and other authors declare no conflict of interest.
Statements on human and animal rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee (Ethics Committee, University hospital Hradec Kralove, Czech Republic, reference code 201603S-12) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all participants included in the study.
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