Comparison of Elastic Tourniquet and Blood Pressure Cuff for Peripheral Intravenous Access in Hypotensive Patients: A
İlker Şirin1, Şerife Büşra Uysal1, Afşin Emre Kayıpmaz1
1Department of Emergency Medicine, Ankara Etlik City Hospital, Ankara, Turkey.
Insights
For hypotensive patients needing intravenous access, a blood pressure cuff (BPC) is more effective for venodilatation than an elastic tourniquet (ET). BPC significantly increases vein diameter and improves first-attempt success rates for peripheral intravenous catheterization (PIVC).
Area of Science:
- Emergency Medicine
- Vascular Access
- Clinical Trials
Background:
- Peripheral intravenous catheterization (PIVC) is a common emergency department (ED) procedure.
- Elastic tourniquets (ET) and blood pressure cuffs (BPC) are standard venodilatation methods.
- Difficult vascular access is common in certain patient groups, leading to lower first-time PIVC success rates.
Purpose of the Study:
- To determine the most effective venodilatation method for hypotensive patients in the ED.
- To compare the efficacy of BPC versus ET in facilitating PIVC in hypotensive individuals.
Main Methods:
- Prospective, single-blind, randomized controlled trial involving 101 hypotensive patients.
- Patients were randomized to receive venodilatation via ET or BPC.
- Basilic vein diameter and collapsibility were measured pre- and post-intervention; initial IV access success rate was recorded.
Main Results:
- Blood pressure cuffs (BPC) resulted in a significantly greater increase in basilic vein diameter (5.4 mm) compared to elastic tourniquets (ET) (4.5 mm) (p < .0001).
- First-attempt IV access success was higher with BPC (63%) than with ET (41%).
- Greater improvement in vein collapsibility was observed with BPC.
Conclusions:
- Blood pressure cuffs (BPC) are superior to elastic tourniquets (ET) for venodilatation in hypotensive patients undergoing PIVC insertion.
- BPC offers a greater increase in basilic vein diameter and improved initial access success rates.
- BPC is recommended for venodilatation in hypotensive patients requiring PIVC in the emergency department.
Background:
Peripheral intravenous catheterization (PIVC) is one of the most common invasive procedures performed in emergency departments (EDs). Elastic tourniquets (ET) and blood pressure cuffs (BPC) are most commonly used for venodilatation. Difficult vascular access can be predicted in some patients, and the rate of successful first-time PIVC placement in this group is low.
Objective:
In this study, we investigated which venodilatation method is most appropriate for hypotensive patients, a group in whom vascular access is predicted to be difficult.
Methods:
This was a prospective, single-blind, randomized controlled trial in the ED of a tertiary care hospital. Hypotensive patients were randomly assigned to two methods of administration. Patients' basilic vein diameters and venous collapsibility were measured before and after the intervention by a physician blinded to the intervention, followed by intravenous (IV) access. The primary outcome was the change in basilic vein diameter after the applied venodilatation method (ET or BPC), and the secondary outcomes were the change in vein collapsibility and initial access success rate.
Results:
In this study of 101 patients, basilic vein diameter increased from 4.05 to 5.4 mm in the BPC group and from 4.1 to 4.5 mm in the ET group. The change in diameter in the BPC group was greater than that in the ET group (p < .0001). In addition, IV access was successful in 33 (63%) of 52 patients in the BPC group on the first attempt and in 20 (41%) of 49 patients in the ET group. The change in collapsibility was greater in the BPC group after the procedure.
Conclusion:
BPC during PIVC insertion in hypotensive patients presenting to the ED showed both a greater increase in basilic vein diameter and superior initial access success than ET. Therefore, we recommend BPC as a method of venodilatation in hypotensive patients.
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