Ultrasound-Guided Peripheral Intravenous Access by Critical Nurses.

Study Overview
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Brief Summary
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Peripheral intravenous access is a major intervention in patients admitted to an intensive care unit. Systematically performed by nurses, it is also an essential intervention when the central venous access has to be removed. However, in the intensive care unit, patient centered-characteristics such as previous history of intravenous drug abuse, obesity, history of multiple vascular punctures or fluid overload most often affect the success rate of this procedure. For these patients, failure consequences are numerous: 1) delayed discharge from the intensive care unit, 2) increased pain and dissatisfaction, 3) increased incidence of catheter-related bloodstream infections. The use of ultrasound has gained increasing popularity particularly for obtaining central venous access. We hypothesize that, among trained nurses, ultrasound-guided peripheral venous access could represent an attractive alternative compared to the traditional anatomical method in order to increase the success rate.

Official Title
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Contribution of Ultrasound for Peripheral Intravenous Catheter Placement by Intensive Care Nurses

Conditions
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Venous Catheterization

Intervention / Treatment
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* Device: Vascular ultrasound system


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patient admitted in ICU patient not able to express his opposition central venous access that need to be removed need for a peripheral venous access no clinical instability no visible superficial vein due to: BMI> 30, fluid overload, previous history of IV drug abuse, previous history of chemotherapy , Exclusion Criteria: patient < 18 yo pregnancy patient under protective supervision need for a central venous access

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Classical method of peripheral venous catheterization<br>Classical method will be applied only on arm and forearm. | |
| Experimental: Ultrasound guided peripheral venous catheterization<br>Nurse will use a vascular ultrasound system to orient the catheter toward the peripheral vein. Ultrasound method will be applied only on arm and forearm. | Device: Vascular ultrasound system<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| number of peripheral venous catheterization attempts | Each day, only 3 attempts are allowed | up to day 2 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of central lines removed |  | intraoperative | 
| central venous catheter dwell time | defined period between insertion and removal of the central venous line | intraoperative | 
| peripheral venous catheter dwell time | defined period between insertion and removal of the peripheral catheter with a maximum of 3 days. | intraoperative | 
| number of central line catheter related infection |  | intraoperative | 
| number of central line catheter related colonization |  | intraoperative | 
| Diameter of the inserted peripheral venous catheter | at peripheral venous catheter insertion | day 0, or day 1 or day 2 | 
| patient satisfaction | assessed by an analogic scale | intraoperative | 
| nurse satisfaction | assessed by a survey form | intraoperative | 
| Proportion of peripheral venous catheter successful placement |  | at day 0, day 1, day 2 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ultrasound, nurse, Peripheral venous catheter, Intensive Care Units