Abstract
Introduction
Vascular access procedures are among the most commonly performed procedures in the
emergency department. The objective of the current study was to compare the contrast
extravasation rate for ultrasound-guided peripheral intravenous (USGPIV) catheter
placement by emergency nurses with peripheral intravenous catheters placed by standard
landmark techniques.
Methods
A retrospective chart review of all ED patients at our urban tertiary-care institution
who underwent contrasted computed tomography examination and suffered contrast extravasation
events was performed. A logbook of all ED patients who underwent USGPIV placement
and an institution-wide electronic patient safety incident-reporting system was reviewed
for all contrast extravasation events between May 2014, and February 2017. Data were
analyzed using descriptive statistics, Student t-tests for continuous data, and χ2 or Fisher’s exact test for categorical data.
Results
One thousand five hundred USGPIV catheters were placed by 27 emergency nurses. Contrast
material was administered 29,508 times, and, of these, 291 were administered via USGPIV
placement. There were 74 peripheral IV lines with documented contrast extravasations
(0.25%) as reported in the safety-event database; 12 (4.1%) were from the USGPIV population,
and 62 (0.21%) occurred in the standard landmark technique population. Relative risk
of contrast extravasation events with USGPIV placement was 19.4 (95% confidence interval
[CI], 10.6-35.6), and the absolute risk difference was 3.9% (95% CI 1.6%-6.2%).
Discussion
USGPIV placement by trained emergency nurses has higher rates of contrast extravasation
than with standard landmark technique placement.
Key words
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References
- Risk factors associated with difficult venous access in adult ED patients.Am J Emerg Med. 2014; 32: 1179-1182https://doi.org/10.1016/j.ajem.2014.07.008
- Predicting peripheral venous access difficulty in the emergency department using body mass index and a clinical evaluation of venous accessibility.J Emerg Med. 2013; 44: 299-305https://doi.org/10.1016/j.jemermed.2012.07.051
- A nurse-led ultrasound-enhanced vascular access preservation program.Am J Nurs. 2017; 117: 56-64https://doi.org/10.1097/01.NAJ.0000527490.24610.51
- Ultrasound-guided peripheral intravenous access program is associated with a marked reduction in central venous catheter use in noncrticially ill emergency department patients.Ann Emerg Med. 2013; 61: 198-203https://doi.org/10.1016/j.annemergmed.2012.09.016
- Extravasation risk using ultrasound-guided peripheral intravenous catheters for computed tomography contrast administration.Acad Emerg Med. 2016; 23: 918-921https://doi.org/10.1111/acem.13000
- Contrast medium extravasation injury: guidelines for prevention and management.Eur Radiol. 2002; 12: 2807-2812https://doi.org/10.1007/s00330-002-1630-9
- Frequency, management and outcome of extravasation of nonionic iodinated contrast medium in 69,657 intravenous injections.Radiology. 2007; 243: 80-87
- The effect of vessel depth, diameter, and location on ultrasound-guided peripheral intravenous catheter longevity.Am J Emerg Med. 2012; 30: 1134-1140https://doi.org/10.1016/j.ajem.2011.07.027
Biography
Mark Favot is a physician at Wayne State University School of Medicine and Chief, Section of Emergency Ultrasound, Department of Emergency Medicine, Sinai-Grace Hospital, Detroit, MI.
Biography
John Gallien is a physician at Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, MI.
Biography
Adrienne Malik is a physician at Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, MI.
Biography
Adam Kasten is a nurse at Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, MI.
Biography
Robert Wells is a nurse at Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, MI.
Biography
Robert Ehrman is a physician at Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, MI.
Article info
Footnotes
Earn Up to 5.5 Hours. See page 594.
Identification
Copyright
© 2019 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
