Technique of ultrasound-guided peripheral venous access in the emergency room

Background: “Difficult intravenous access” patients represent a challenge within an emergency department as they often require many attempts to insert a peripheral short cannula in the emergency room or during the whole hospitalization. This can lead to many problems in terms of patient discomfort, increase of cost, and prolonged treatment time. Objectives: This study aimed to reduce the number of attempts needed for a short-cannula insertion or preventing insertion of a central vascular access by placing an ultrasound-guided long cannula during the emergency department visit. Material and methods: The insertion of mini-midline was monitored within an emergency room in 50 patients considered difficult intravenous access patients, who failed two attempts at peripheral venous access insertion and/or required the use of an alternative vascular device. Results: A total of 46 patients out of 50 were monitored. In 38 (82%) patients, the device was removed due to the end of the indication, and in six of them, it was replaced by a central venous catheter. Two devices were left inside even after discharge and were then removed at the end of indication. In eight (17%) patients, the device was removed due to accidental removal (4) and malfunction (4). In all the cases, the average duration of the insertion procedure was 10 min. The mean dwell time accounted to 7 and 9 days. Conclusion: The insertion of a mini-midline as part of the first emergency room visit in selected patients is a rapid, safe, and cost-effective procedure, which can provide the patient with stable venous access during the all hospitalization time.

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Ultrasound-guided Peripheral Venous Access: A Comparison of Two Techniques: Locate, Align, Puncture (LAP) Versus Locate, Align, Mark, Puncture (LAMP)

Academic Emergency Medicine ◽

10.1197/j.aem.2007.03.988 ◽

2007 ◽

Vol 14 (5 Supplement 1) ◽

pp. S103-S103

Author(s):

J. Resnick ◽

R. Cydulka ◽

J. Donato ◽

R. Jones ◽

S. Werner

Keyword(s):

Venous Access ◽

Ultrasound Guided ◽

Peripheral Venous Access

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Ultrasound-guided Peripheral Venous Access

Applications of Ultrasound in Anesthesia A Handbook ◽

10.5005/jp/books/14204_5 ◽

2018 ◽

pp. 66-66

Author(s):

Kavita Lalchandani

Keyword(s):

Venous Access ◽

Ultrasound Guided ◽

Peripheral Venous Access

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Midline catheters for extracorporeal photopheresis in hematological patients

The Journal of Vascular Access ◽

10.1177/11297298211041450 ◽

2021 ◽

pp. 112972982110414

Author(s):

Bruno Marche ◽

Sonia D’Arrigo ◽

Maria Giuseppina Annetta ◽

Andrea Musarò ◽

Alessandro Emoli ◽

...

Keyword(s):

Central Venous Access ◽

Venous Access ◽

Extracorporeal Photopheresis ◽

Ultrasound Guided ◽

Central Venous ◽

Graft Versus Host ◽

Single Lumen ◽

Peripheral Venous Access ◽

Preliminary Study ◽

Venous Access Devices

Introduction: Peripheral venous access for extracorporeal photopheresis (ECP) may be difficult in graft versus host disease (GVHD) patients, because of previous intravenous therapies and multiple peripheral cannulations; in this population of patients, ultrasound guided midline catheters may be an alternative option to central venous access. Methods: In this single-center, prospective preliminary study, we enrolled all consecutive patients with a diagnosis of GVHD and candidate to ECP, over a period of 10 months. We used inserted power injectable, non-valved, polyurethane, 20–25 cm single lumen midline catheters (MC). Results: Sixty-nine ECP procedures were carried out in six patients, using single-lumen MCs for outflow (5Fr in 74% and 4Fr in 26% of cases). For inflow, we used 5Fr or 4Fr MCs, or central venous access devices previously placed for other clinical reasons. There were no catheter-related complications during the entire period of ECP treatment. Mean outflow was significantly higher for 5Fr than for 4Fr MCs (35.8 ± 7.3 vs 29.2 ± 7.8 ml/min; p = 0.0008) and the procedure time was significantly shorter (92.9 ± 9.2 vs 108 ± 13.2 min; p < 0.0001). Conclusion: In GVHD patients, ECP can be performed efficiently and safely using single lumen polyurethane power injectable MCs. The best results are obtained with 5Fr rather than with 4Fr catheters. This strategy of venous access should be implemented in DIVA patients requiring ECP treatments, and probably also in other types of apheresis.

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