Nurse-led Placement of Peripheral Venous Catheters in Overweight Patients Using Standard or Dynamic Ultrasound-guided Technique

Study Overview
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Brief Summary
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Overweight and obesity may be associated with difficult intravenous access leading to longer procedure time and more placement attempts of peripheral venous catheters (PVC). Dynamic ultrasound-guided short-axis needle tip navigation (DUST) may facilitate the procedure. This was a prospective, randomized, non-blinded study to compare time and placement attempts for nurse-led standard (ST) and ultrasound guided PVC placement in 90 emergency patients with a BMI ≥25kg/m2. Consenting patients were randomized at a 1:1 ratio to receive PVC by either ST or DUST. Application time was defined as the time from applying stasis to visible blood in the PVC flash-chamber. No difference in time was found (medians: ST 42 s; DUST 53.5 s, P = 0.535). There were on average 17 % less placement attempts in the DUST-group (median 1 attempt; Q1 = 1 Q3 = 1) compared to the ST-group (median 1 attempt; Q1 = 1 Q3 = 1.5), (p = 0.031). Patients reported no differences in perceived pain (p = 0.955) or perceived satisfaction (p = 0.342). Pain and subcutaneous infiltrations were the only side-effects reported (ST-group 6, DUST-group 5). DUST does not decrease time to functional PVC but reduces the number of PVC placement attempts in patients with BMI ≥25 kg/m2.

Official Title
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A Randomized, Controlled Comparison of Nurse-led Placement of Peripheral Venous Catheters in Overweight Patients Using Standard or Dynamic Ultrasound-guided Technique

Conditions
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Overweight and Obesity, Emergencies

Intervention / Treatment
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* Device: Dynamic ultrasound-guided short-axis needle tip navigation
* Other: Standard technique of placing a PVC


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: REETS prioritization level of Orange, Yellow, Green or Blue 18 years old BMI ≥25 Kg/m2 Need of PVC according to Emergency department guidelines Able to give written informed consent Exclusion Criteria: Unable or unwilling to provide informed consent Life threatening patient status (REETS prioritization level of Red) Immunosuppression Pregnant or lactating women Blood infections Puncture zone skin damaged (burns, eczema, infection)

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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Standard Technique PVC placement<br>Standard PVC placement technique | Other: Standard technique of placing a PVC<br>* Standard technique with palpation or Visual inspection of the pvc placement site<br>|
| Experimental: DUST<br>Dynamic ultrasound-guided short-axis needle tip navigation (DUST) | Device: Dynamic ultrasound-guided short-axis needle tip navigation<br>* placement of peripheral venous catheters using ultrasound guided technique<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to application | Application time was defined as the time from applying stasis to visible blood in the PVC flash-chamber. | 1 hour | 
| Number of cannulation attempts | The total number of cannulation attempts performed per patient | 1 hour | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient satisfaction | The perceived satisfaction of the patient as indicated by Numeric Rating scale (NRS, 0 = not satisfied, 10 = maximum satisfaction) | 1 hour | 
| Perceived Pain | The perceived pain of the patient as indicated by Numeric Rating scale (NRS, 0 = no pain, 10 = the worst pain possible) | 1 hour | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Nurse led, Ultrasound, Emergency department, Overweight, Obesity