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"Ultrasound-guided GSV PIV placement is a feasible alternative in situations of difficult i.v. access" Smoot et al (2022).

Ultrasound-guided great saphenous vein access


Background: Early recognition of difficult intravenous (i.v.) access and use of ultrasound-guided techniques prior to multiple attempts are important steps in improving patient care in the emergency department (ED). Success rates for ultrasound-guided peripheral i.v. (PIV) cannulation are affected by depth, size of target vessel, and predictability of anatomy. The great saphenous vein (GSV) in the medial distal thigh may provide an alternative site for ultrasound-guided cannulation in cases of difficult peripheral venous access.

Objectives: Our objective was to determine the feasibility of ultrasound-guided GSV PIV placement as an alternative site for patients with difficult i.v. access.

Methods: Participants were prospectively enrolled from a convenience sample of patients presenting to the ED in June and July 2019. Inclusion criteria were age 18 years and older, and a history of difficult i.v. access or two unsuccessful nursing staff attempts. Ultrasound-guided access was conducted with an in-plane or out-of-plane approach on the basis of proceduralist preference.

Results: Twenty patients were enrolled; 1 patient withdrew consent prior to cannulation. GSV cannulation was successful in 14 (73.7%) of the 19 patients. Phlebotomy, blood transfusion, i.v. medications including norepinephrine, and i.v. computed tomography contrast medium were successfully performed via GSV access. No reported infection, thrombosis, or extravasation was identified throughout the cannulation dwell time, hospitalization, or for 72 h after discharge.

Conclusion: Ultrasound-guided GSV PIV placement is a feasible alternative in situations of difficult i.v. access. No unforeseen complication or safety issue was identified. Blood products, medications, and contrast medium were successfully administered safely.


Smoot WA, Hopp SL, Barzee BM, Bardwell AJ, Kummer T. Ultrasound-Guided Great Saphenous Vein Access: Revisiting an Old Friend in a New Location. J Emerg Med. 2022 Jan 4:S0736-4679(21)00752-6. doi: 10.1016/j.jemermed.2021.10.006. Epub ahead of print. PMID: 34996672.