Maneuvers to assist ultrasound peripheral access

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Intravenous literature: Mahler, S.A., Massey, G., Meskill, L., Wang, H. and Arnold, T.C. (2011) Can we make the basilic vein larger? Maneuvers to facilitate ultrasound guided peripheral intravenous access: a prospective cross-sectional study. International Journal of Emergency Medicine. 4(1), p.53. [Epub ahead of print]

Abstract:

BACKGROUND: Studies have shown that vein size is an important predictor of successful ultrasound guided vascular access. The objective of this study is to evaluate maneuvers designed to increase basilic vein size, which could be used to facilitate ultrasound guided peripheral intravenous access (USGPIV) in the Emergency Department (ED) setting.

METHODS: This was a prospective non-randomized trial. Healthy volunteers aged 18-65 were enrolled. Basilic veins were identified and cross-sectional area measured sonographically. Following baseline measurement, the following maneuvers were performed; application of tourniquet, inflation of a blood pressure (BP) cuff, application of a tourniquet with the arm lowered, and BP cuff inflation with the arm lowered. Following each maneuver there was 30 seconds of recovery time and a baseline measurement was repeated to ensure that the vein had return to baseline. Change in basilic vein size was modeled using mixed model analysis with a Tukey correction for multiple comparisons to determine if significant differences existed between different maneuvers.

RESULTS: Over the 5 month study period, 96 basilic veins were assessed from 52 volunteers. All of the maneuvers resulted in a statistically significant increase in basilic vein size from baseline (p < 0.001). BP cuff inflation had the greatest increase in vein size from baseline 17%, 0.87 mm 95%CI (0.70-1.04). BP cuff inflation statistically significantly increased vein size compared to tourniquet placement by 3%, 0.16 mm 95%CI (0.02-0.30).

CONCLUSIONS: The largest increase in basilic vein size was due to blood pressure cuff inflation. BP cuff inflation resulted in a statistically significant increase in vein size compared to tourniquet application, but this difference may not be clinically significant.

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