Ultrasonography Versus Landmark for Peripheral Intravenous Cannulation: A Randomized Controlled Trial

Area of Science:

• Emergency Medicine
• Medical Imaging
• Surgical Procedures

Background:

• Peripheral intravenous cannulation (PIVC) is a common procedure.
• Success rates vary, especially in patients with difficult venous access.
• Existing research comparing landmark and ultrasonography methods yields inconsistent findings.

Purpose of the Study:

• To compare the initial success rates of PIVC using landmark guidance versus ultrasonography.
• To determine the superior method for patients with varying degrees of venous access difficulty.

Main Methods:

• A randomized controlled trial involving 1,189 adult emergency department patients.
• Patients were stratified into difficult, moderately difficult, or easy venous access categories.
• Peripheral intravenous cannulations were performed by ED technicians using either landmark or ultrasonography guidance.

Main Results:

• Overall initial success rate was 81%.
• Ultrasonography showed higher success rates for difficult (48.0% more) and moderately difficult (10.2% more) access.
• Landmark guidance was more successful for easy access (10.6% more).

Conclusions:

• Ultrasonography is advantageous for PIVC in patients with difficult or moderately difficult venous access.
• The landmark approach is more effective for patients with anticipated easy venous access.