Stick Or Switch: The Diminishing Returns Of Repeated Peripheral Intravenous Access Attempts In Hypotensive Trauma...

Area of Science:

• Emergency Medicine
• Trauma Care
• Vascular Access

Background:

• Peripheral intravenous (PIV) access is standard for trauma patients.
• Optimal timing for alternative vascular access is not established.
• This study evaluates PIV success in hypotensive trauma patients.

Purpose of the Study:

• Characterize PIV success rates in hypotensive trauma patients.
• Identify factors associated with PIV success.
• Determine the marginal yield of sequential PIV attempts.

Main Methods:

• Analysis of audiovisual recordings from trauma resuscitations.
• Prospective, multicenter study of hypotensive patients (SBP <90mmHg).
• Generalized estimating equations used for statistical analysis.

Main Results:

• 886 PIV attempts in 471 patients; overall success rate 67.1%.
• Male sex and measurable initial systolic blood pressure correlated with success.
• Cumulative success reached 83% by the second attempt; marginal success declined after the second attempt.

Conclusions:

• PIV access is successful in approximately two-thirds of hypotensive trauma patients.
• Marginal yield of sequential PIV attempts decreases significantly after two failures.
• Consider alternative vascular access after one failed PIV attempt in patients without measurable blood pressure.