Ultrasound-guided peripheral venous cannulation: technique and complications in comparison with conventional techniques

OBJECTIVES. To describe the use of ultrasound-guided peripheral venous cannulation in an emergency department (ED). To compare the incidence of complications with this technique to those in conventional placement of an intravenous line.
METHODS. Observational, descriptive, retrospective study in the ED of Hospital Universitario de Cabueñes in Spain. We collected data on 108 cannulation attempts in adults with difficult venous access, recording success or failure of placement, characteristics of the punctured vein, time the catheter remained in place, and the reason for removal. The incidence of complications was calculated and compared to the findings of our earlier study on traditional venous line placement.
RESULTS. Venous access was successful in 86.1% of the cases. Out-of-plane imaging was used in the majority of attempts (80.6%). Placement was in the basilica vein in 52.7%, and at a mean (SD) depth of 6.2 (2.2) mm. The mean venous diameter was 4.5 (0.9) mm, and 35 catheters remained in place 24 hours on average. Complications occurred in 12 of the 35 (34.2%). Extravasation (in 14.2%) was the most frequent complication; phlebitis developed in 5.7%. Fewer cases of obstruction occurred with ultrasound guidance than with the traditional technique. There were no differences with respect to the incidences of phlebitis, extravasation, or accidental removal. No associations were found between any variables (catheter, vein accessed, depth, or diameter) and time the catheter was in place or the reason for removal.
CONCLUSIONS. Ultrasound-guided peripheral venous cannulation is a useful technique in patients with difficult venous access. Complications are no more frequent than with the conventional technique for placement of a venous line.