Ultrasonographically Guided Insertion of a 15-cm Catheter Into the Deep Brachial or Basilic Vein in Patients With Difficult Intravenous Access

Study objective Standard length (3 to 5 cm) intravenous catheters in the deep brachial or basilic vein tend to dislodge prematurely. We assess the safety and longevity of a 15-cm catheter inserted in these veins by a novel ultrasonographically guided technique. Methods This is a prospective cohort s...

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Veröffentlicht in:Annals of emergency medicine 2007-07, Vol.50 (1), p.68-72
Hauptverfasser: Mills, Christopher N., MD, Liebmann, Otto, MD, Stone, Michael B., MD, Frazee, Bradley W., MD
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container_issue 1
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container_title Annals of emergency medicine
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creator Mills, Christopher N., MD
Liebmann, Otto, MD
Stone, Michael B., MD
Frazee, Bradley W., MD
description Study objective Standard length (3 to 5 cm) intravenous catheters in the deep brachial or basilic vein tend to dislodge prematurely. We assess the safety and longevity of a 15-cm catheter inserted in these veins by a novel ultrasonographically guided technique. Methods This is a prospective cohort study conducted in an urban teaching emergency department (ED). Adult subjects were enrolled if 2 peripheral intravenous insertion attempts had failed. A 3.2-cm, 18-gauge catheter was first inserted into the deep brachial or basilic vein under ultrasonographic guidance. In a separate step, a wire was inserted through this catheter, and a 15-cm, 16-gauge catheter was placed over the wire and left in place for up to 3 days. Primary outcomes were time to securing access and rate of loss of access. Secondary outcomes included complication rates and subject satisfaction. Results Twenty-five subjects were enrolled; 23 catheters were successfully placed. Median time required for initial vein cannulation was 3 minutes (interquartile range [IQR] 2 to 7 minutes) and for securing the 15-cm catheter was an additional 4 minutes (IQR 3 to 5 minutes). Median duration of access was 26 hours (IQR 10 to 47 hours). The only complication was early infiltration in 1 subject. All subjects rated satisfaction as 4 or 5 on a 5-point Likert scale. Conclusion We present a promising alternative to central venous catheterization in patients with difficult intravenous access. This technique appears to be fast, safe, and well tolerated by adult patients.
doi_str_mv 10.1016/j.annemergmed.2007.02.003
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We assess the safety and longevity of a 15-cm catheter inserted in these veins by a novel ultrasonographically guided technique. Methods This is a prospective cohort study conducted in an urban teaching emergency department (ED). Adult subjects were enrolled if 2 peripheral intravenous insertion attempts had failed. A 3.2-cm, 18-gauge catheter was first inserted into the deep brachial or basilic vein under ultrasonographic guidance. In a separate step, a wire was inserted through this catheter, and a 15-cm, 16-gauge catheter was placed over the wire and left in place for up to 3 days. Primary outcomes were time to securing access and rate of loss of access. Secondary outcomes included complication rates and subject satisfaction. Results Twenty-five subjects were enrolled; 23 catheters were successfully placed. Median time required for initial vein cannulation was 3 minutes (interquartile range [IQR] 2 to 7 minutes) and for securing the 15-cm catheter was an additional 4 minutes (IQR 3 to 5 minutes). Median duration of access was 26 hours (IQR 10 to 47 hours). The only complication was early infiltration in 1 subject. All subjects rated satisfaction as 4 or 5 on a 5-point Likert scale. Conclusion We present a promising alternative to central venous catheterization in patients with difficult intravenous access. This technique appears to be fast, safe, and well tolerated by adult patients.</description><identifier>ISSN: 0196-0644</identifier><identifier>EISSN: 1097-6760</identifier><identifier>DOI: 10.1016/j.annemergmed.2007.02.003</identifier><identifier>PMID: 17433498</identifier><identifier>CODEN: AEMED3</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Arm ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Catheterization, Central Venous - instrumentation ; Catheterization, Central Venous - methods ; Catheters, Indwelling ; Cohort Studies ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Emergency ; Emergency and intensive care: techniques, logistics ; Emergency Medicine - methods ; Humans ; Intensive care medicine ; Medical sciences ; Middle Aged ; Patient Satisfaction ; Perfusions. Catheterizations. 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We assess the safety and longevity of a 15-cm catheter inserted in these veins by a novel ultrasonographically guided technique. Methods This is a prospective cohort study conducted in an urban teaching emergency department (ED). Adult subjects were enrolled if 2 peripheral intravenous insertion attempts had failed. A 3.2-cm, 18-gauge catheter was first inserted into the deep brachial or basilic vein under ultrasonographic guidance. In a separate step, a wire was inserted through this catheter, and a 15-cm, 16-gauge catheter was placed over the wire and left in place for up to 3 days. Primary outcomes were time to securing access and rate of loss of access. Secondary outcomes included complication rates and subject satisfaction. Results Twenty-five subjects were enrolled; 23 catheters were successfully placed. Median time required for initial vein cannulation was 3 minutes (interquartile range [IQR] 2 to 7 minutes) and for securing the 15-cm catheter was an additional 4 minutes (IQR 3 to 5 minutes). Median duration of access was 26 hours (IQR 10 to 47 hours). The only complication was early infiltration in 1 subject. All subjects rated satisfaction as 4 or 5 on a 5-point Likert scale. Conclusion We present a promising alternative to central venous catheterization in patients with difficult intravenous access. This technique appears to be fast, safe, and well tolerated by adult patients.</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Arm</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Catheterization, Central Venous - instrumentation</subject><subject>Catheterization, Central Venous - methods</subject><subject>Catheters, Indwelling</subject><subject>Cohort Studies</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Emergency</subject><subject>Emergency and intensive care: techniques, logistics</subject><subject>Emergency Medicine - methods</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Patient Satisfaction</subject><subject>Perfusions. Catheterizations. Hyperbaric oxygenotherapy</subject><subject>Prospective Studies</subject><subject>Treatment Outcome</subject><subject>Ultrasonography, Interventional - methods</subject><issn>0196-0644</issn><issn>1097-6760</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNks2KFDEQxxtR3HX1FSQe9NZjpT-SyUXYndV1YUFBV48hXV29k7EnGZP0wryEz2yaGVS8aAikoH71kfpXUbzgsODAxevNwjhHWwp3W-oXFYBcQLUAqB8UpxyULIUU8LA4Ba5ECaJpToonMW4AQDUVf1yccNnUdaOWp8WP2zEFE73zd8Hs1hbNOO7Z1WR76tm1ixSS9Y75gRnG2xK3bGXSmhKF7E2eZZtdEu3YRTC4tmZkPrALE-1okX0h61i-H02y5FJkX21as0s7DBanMc0Zgrkn56fIzhEpxqfFo8GMkZ4d37Pi9t3bz6v35c2Hq-vV-U2JjeKpbKjHqpNCtUYONV9KoK7iFfIKGi46iX1ddcLk37YE1MqGD4aQd4CtAByq-qx4dci7C_77RDHprY1I42gc5W60hFYJlSf6L5ArWdcCZAbVAcTgYww06F2wWxP2moOeVdMb_YdqelZNQ6VzjRz7_Fhk6mbfr8ijTBl4eQRMzAoNwTi08Te3XC6F4nMTqwNHeXb3loKOmCeP1NtAmHTv7X-18-avLDhaN6_GN9pT3PgpuCyO5jrmAP1pXrN5y0AC8Dqfn-a-0S0</recordid><startdate>20070701</startdate><enddate>20070701</enddate><creator>Mills, Christopher N., MD</creator><creator>Liebmann, Otto, MD</creator><creator>Stone, Michael B., MD</creator><creator>Frazee, Bradley W., MD</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T2</scope><scope>7U2</scope><scope>C1K</scope><scope>7X8</scope></search><sort><creationdate>20070701</creationdate><title>Ultrasonographically Guided Insertion of a 15-cm Catheter Into the Deep Brachial or Basilic Vein in Patients With Difficult Intravenous Access</title><author>Mills, Christopher N., MD ; Liebmann, Otto, MD ; Stone, Michael B., MD ; Frazee, Bradley W., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c491t-4edc2b7695a7f31870eb212c120416b7cd32b6a9425e0e5741faec1b0c560cf23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Arm</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology. Vascular system</topic><topic>Catheterization, Central Venous - instrumentation</topic><topic>Catheterization, Central Venous - methods</topic><topic>Catheters, Indwelling</topic><topic>Cohort Studies</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Emergency</topic><topic>Emergency and intensive care: techniques, logistics</topic><topic>Emergency Medicine - methods</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Patient Satisfaction</topic><topic>Perfusions. Catheterizations. Hyperbaric oxygenotherapy</topic><topic>Prospective Studies</topic><topic>Treatment Outcome</topic><topic>Ultrasonography, Interventional - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mills, Christopher N., MD</creatorcontrib><creatorcontrib>Liebmann, Otto, MD</creatorcontrib><creatorcontrib>Stone, Michael B., MD</creatorcontrib><creatorcontrib>Frazee, Bradley W., MD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Safety Science and Risk</collection><collection>Environmental Sciences and Pollution Management</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mills, Christopher N., MD</au><au>Liebmann, Otto, MD</au><au>Stone, Michael B., MD</au><au>Frazee, Bradley W., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ultrasonographically Guided Insertion of a 15-cm Catheter Into the Deep Brachial or Basilic Vein in Patients With Difficult Intravenous Access</atitle><jtitle>Annals of emergency medicine</jtitle><addtitle>Ann Emerg Med</addtitle><date>2007-07-01</date><risdate>2007</risdate><volume>50</volume><issue>1</issue><spage>68</spage><epage>72</epage><pages>68-72</pages><issn>0196-0644</issn><eissn>1097-6760</eissn><coden>AEMED3</coden><abstract>Study objective Standard length (3 to 5 cm) intravenous catheters in the deep brachial or basilic vein tend to dislodge prematurely. We assess the safety and longevity of a 15-cm catheter inserted in these veins by a novel ultrasonographically guided technique. Methods This is a prospective cohort study conducted in an urban teaching emergency department (ED). Adult subjects were enrolled if 2 peripheral intravenous insertion attempts had failed. A 3.2-cm, 18-gauge catheter was first inserted into the deep brachial or basilic vein under ultrasonographic guidance. In a separate step, a wire was inserted through this catheter, and a 15-cm, 16-gauge catheter was placed over the wire and left in place for up to 3 days. Primary outcomes were time to securing access and rate of loss of access. Secondary outcomes included complication rates and subject satisfaction. Results Twenty-five subjects were enrolled; 23 catheters were successfully placed. Median time required for initial vein cannulation was 3 minutes (interquartile range [IQR] 2 to 7 minutes) and for securing the 15-cm catheter was an additional 4 minutes (IQR 3 to 5 minutes). Median duration of access was 26 hours (IQR 10 to 47 hours). The only complication was early infiltration in 1 subject. All subjects rated satisfaction as 4 or 5 on a 5-point Likert scale. Conclusion We present a promising alternative to central venous catheterization in patients with difficult intravenous access. This technique appears to be fast, safe, and well tolerated by adult patients.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>17433498</pmid><doi>10.1016/j.annemergmed.2007.02.003</doi><tpages>5</tpages></addata></record>
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subjects Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Arm
Biological and medical sciences
Blood and lymphatic vessels
Cardiology. Vascular system
Catheterization, Central Venous - instrumentation
Catheterization, Central Venous - methods
Catheters, Indwelling
Cohort Studies
Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous
Emergency
Emergency and intensive care: techniques, logistics
Emergency Medicine - methods
Humans
Intensive care medicine
Medical sciences
Middle Aged
Patient Satisfaction
Perfusions. Catheterizations. Hyperbaric oxygenotherapy
Prospective Studies
Treatment Outcome
Ultrasonography, Interventional - methods
title Ultrasonographically Guided Insertion of a 15-cm Catheter Into the Deep Brachial or Basilic Vein in Patients With Difficult Intravenous Access
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