Mono- and bi-plane sonographic approach for difficult accesses in the emergency department - A randomized trial

Davide Enrici Baion; Alberto La Ferrara; Davide Maserin; Stefania Caprioli; Rosina Albano; Francesco Malara; Francesca Locascio; Emanuela Galluzzo; Deborah Luison; Matteo Lombardo; Roberta Navarra; Gilberto Calzolari; Maria Tizzani; Isabella Prisciandaro; Fulvio Morello; Pietro Tuttolomondo; Alberto Goffi; Enrico Lupia; Emanuele Pivetta

doi:10.1016/j.ajem.2023.09.018

Mono- and bi-plane sonographic approach for difficult accesses in the emergency department - A randomized trial

Am J Emerg Med. 2023 Dec:74:49-56. doi: 10.1016/j.ajem.2023.09.018. Epub 2023 Sep 23.

Authors

Davide Enrici Baion¹, Alberto La Ferrara¹, Davide Maserin¹, Stefania Caprioli¹, Rosina Albano², Francesco Malara¹, Francesca Locascio¹, Emanuela Galluzzo¹, Deborah Luison¹, Matteo Lombardo¹, Roberta Navarra¹, Gilberto Calzolari³, Maria Tizzani³, Isabella Prisciandaro¹, Fulvio Morello⁴, Pietro Tuttolomondo⁵, Alberto Goffi⁶, Enrico Lupia⁴, Emanuele Pivetta⁷

Affiliations

¹ Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy.
² High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy.
³ Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy.
⁴ Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy; Department of Medical Sciences, University of Turin, 10126, Turin, Italy.
⁵ Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy; Department of Healthcare Providers, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy.
⁶ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
⁷ Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy; Department of Medical Sciences, University of Turin, 10126, Turin, Italy. Electronic address: emanuele.pivetta@unito.it.

PMID: 37774550
DOI: 10.1016/j.ajem.2023.09.018

Abstract

Background: The insertion of peripheral intravenous (PIV) catheters is one of the most performed invasive procedures in acute healthcare settings. However, peripheral difficult vascular access (PDVA) is not uncommon and can lead to delays in administering essential medications. Ultrasound (US) has emerged as a valuable tool for facilitating PIV cannulation. Advancements in technology have introduced a technique known as bi-plane imaging, allowing the simultaneous display of both longitudinal and transverse views of vessels. We aimed to investigate whether the utilization of bi-plane imaging, as opposed to the single-plane approach, would yield superior results for PDVA in the emergency department (ED).

Methods: This study was a single-center randomized controlled trial. We included adult patients admitted to the ED who required PIV cannulation. Patients were randomly assigned to undergo cannulation using either the mono-plane or bi-plane approach, both performed by skilled providers. The primary outcome of the study was to compare the first attempt success rates between the two techniques.

Results: A total of 442 patients were enrolled, with 221 undergoing cannulation attempts using the mono-plane approach. Successful placement of a functioning PIV catheter was achieved in a single attempt for 313 out of 442 patients (70.8%). There was no significant difference in the success rates between the two study groups: 68.3% in the mono-plane group and 73.3% in the bi-plane group (p = 0.395). The median time required for a successful attempt differed between the groups, with 45 s (range 18-600) in the mono-plane group and 35 s (range 20-600) in the bi-plane group (p = 0.03).

Conclusions: Our study confirms that US is a highly effective tool for facilitating PIV cannulation in patients with PDVA presenting to the ED. However, our investigation into the use of bi-plane imaging did not reveal a significant improvement when compared to mono-plane imaging.

Keywords: Bi-plane imaging; Emergency medicine; Point-of-care ultrasound; Vascular access.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Catheterization, Peripheral* / methods
Emergency Service, Hospital
Humans
Prospective Studies
Ultrasonography
Ultrasonography, Interventional / methods