Comparison of Ultrasound-Guided Modified Seldinger Technique Versus Deep Peripheral Vein Intravenous Catheter Placement with Ultrasound Alone in Patients with Difficult Intravenous Access

Monday, 12 July 2010: 3:05 PM

William G. Warrington, PhD, RN
Advanced Practice Nursing & Research, Orlando Health, Orlando, FL
Teresa A. Kamps, RN, CRNI
Peripherally Inserted Central Catheter Department, Orlando Regional Medical Center, Orlando, FL

Learning Objective 1: discuss complications associated with ultrasound-guided intravenous access

Learning Objective 2: describe an intravenous alternative for patients with difficult intravenous access.

Purpose: Many patients have difficult intravenous (IV) access, and may require ultrasound-guided (USG) IV catheter placement. USG placement is done in a deep vein in the upper extremity by infusion specialist nurses; these catheters dislodge easily and often result in extravasation. Ultrasound-guided modified Seldinger technique (USMST), using a wire to guide IV placement, may be an alternative to USG. This project evaluated outcomes of USMST versus USG for IV catheter insertion in patients that fail traditional IV access. 

Methods: A randomized controlled trial of 105 subjects presenting for outpatient procedures who had failed IV access was conducted. Subjects were referred to the infusion specialist for IV insertion. Subjects were randomly assigned to either the USMST treatment (n=53) or USG control (n=52) arm. Experienced infusion specialist nurses performed both procedures. Complications and patient satisfaction were assessed 72 hours after the procedure. Endpoints were IV access success rate, time from first percutaneous attempt to successful cannulation, number of percutaneous attempts, complications (e.g., hematoma, phlebitis), and patient satisfaction.  Data were analyzed with chi-square and independent t-test statistics.

Results: No significant differences were noted in group characteristics. The majority of subjects were female (58%) admitted for cardiac catheterization (60%); and average age 61 years.  Subjects in the USMST group had a higher success rate (100% versus 90%; p=.021), fewer attempts (1 versus 2; p<.001), shorter insertion time (2 minutes versus 10 minutes; p<.001), and fewer complications (9% versus 44%; p=.001). Hematoma was the most frequent complication observed.  Subject satisfaction was higher in the USMST group (9.7 on 10-point scale versus 5.7; p<.001).

Conclusion: Subjects in the treatment group were more satisfied, had fewer complications, less attempts and the procedure took less time.  IV insertion using USMST is a safe and quick method for infusion specialist nurses to use for patients with difficult IV access.