Please select the eligibility criteria that correspond to the clinical trial below.
Title: Superior Venous Access, Midline vs Ultrasound IVs: A Randomized Clinical Trial
Brief Summary: Obtaining intravenous access (IVA) is the most common procedure performed in the emergency department (ED). Placement of IVA allows for blood work and delivery of intravenous fluids and medications. The implementation of ultrasound guided peripheral IVs (UGPIV) have allowed for ultrasound to be used to place an IV into patients with difficult vein access (DVA). An alternative device to place is a midline catheter (MC). The use of MCs against UGPIV has not been compared in a randomized study. Aim 1: To determine if UGPIVs have a higher failure rate than midline catheters within 72 hours of placement. Aim 2: To collect information to perform a direct cost analysis of UGPIV against that of the midline catheter. Aim 3: Assess patient satisfaction.


Options:
A: Inclusion Criteria:

* 18 years of age or older
* peripheral venous (PIV) access line ordered by a physician during their emergency department visit.

Exclusion Criteria:

* Non-English or non-spanish speaking
* already enrolled in a different study during the ED visit
* too sick, patient requires intravenous access quickly and can not take the time to enroll in study
B: Inclusion Criteria:

* The patient is \>= 21 years of age
* Adult critically ill patients in CCU and MICU requiring short peripheral intravenous access
* The patient has been identified as difficult intravenous access (DIVA), defined as at least two failed blind sticks in the antecubital fossa or more distal upper arm veins
* The patient does not otherwise require a CVC

Exclusion Criteria:

* The patient has a PICC line on the same side as IV placement and has the following:

  * Has a condition poses risk for DIC, inadequate flow, or infection.
  * Has been identified as a site for "Save the Vein" protocol implementation, unless permission is otherwise obtained by the patient's physician.
  * Has a hemodialysis fistula in place on that upper arm side.
* The patient is expected to require therapeutic agent or procedure that necessitates central venous access such as:

  * central venous monitoring
  * Total Parenteral Nutrition
  * Antibiotic requiring central venous access
  * Chemotherapy
  * Vesicants
  * Medications pH less than 5 or more than 9
  * Medications of glucose concentrations above 10%
  * Solution with protein concentrations above 5% (Vascular Access Management, n.d.)
* The patient already has a central venous catheter access, for reasons other than DIVA, through which therapy can be infused
* The patient has renal disease and a "Save The Vein" order is anticipated or pending (serum creatinine \>2mg/dL and GFR \<20) for one of the patient's arms, unless permission is otherwise obtained by the patient's physician
* The patient has a bleeding disorder, unless permission is otherwise obtained by the patient's physician
* The clinician believes the patient is not a good fit for the study or that the procedure is not appropriate for patient at the given moment
C: Inclusion Criteria:

* Patient at least 18 years of age being treated in the emergency department at Boston Medical Center
* Standard IVA cannot be obtained by two qualified ER staff
* Have an upper extremity (left or right arm) that can accept a deep venous IV
* Clinical team believes the patient is likely to require inpatient admission at time of needing IV access
* English speaking
* Able to provide consent

Exclusion Criteria:

* Patient expected to be discharged from the emergency department or discharged from the hospital within 1 nights stay.
* Prisoner
* Pregnancy
* Requires central line or midline catheter as an expected requirement of care
* Patients who are expected to require medication that is not approved for administration via a peripherally guided IV or midline as defined by hospital pharmacy guidelines.
* Patients known to have bacteremia or have a high suspicion of bacteremia
* The patient is known or is suspected to be allergic to materials contained in the device
D: Inclusion Criteria:

* Age ≥ 18
* Identified as requiring a PIVC
* Acceptable vital signs - not requiring emergent resuscitation

Exclusion Criteria:

* Patients triaged as MI alert, brain attack alert, and trauma alert
* Pregnant
* Prisoners
* Institutionalized patients
* Housing insecurity
* Unable to provide consent
* Previously entered into the study

Answer: C