Ultrasound guidance improves first-pass among patients requiring venous cannulation

Ultrasound guiding may improve first-pass and overall cannulation success in patients with challenging landmark method, but it has no discernible impact on discomfort, says an article published in Cochrane Database of Systematic Reviews.

One of the most important procedures in medicine is the insertion of a peripheral intravenous line. It entails inserting a thin, flexible tube (sometimes referred to as a catheter or cannula) using a needle into a vein. This procedure is called "cannulation." It is required when giving medications, delivering fluids, and taking blood samples. In this study, Tada M. and colleagues sought to determine whether ultrasound guidance for peripheral intravenous cannulation in adults was more effective and secure than the landmark technique. They also wanted to know if patients who had cannulation classified as difficult, moderately challenging, or easy used ultrasonography guidance differently.

In this study, papers comparing the outcomes of ultrasonic guidance to the landmark technique for peripheral intravenous cannulation in adults were rigorously looked for. Based on elements such study methodologies and sizes, the results of the studies were aggregated and graded for their confidence in the evidence.

The key findings of this study were;

1. Researchers discovered 16 studies with 2267 participants contrasting the landmark technique with peripheral intravenous cannulation under ultrasound supervision.

2. The effectiveness of ultrasonic guidance was influenced by how challenging it was to cannulate patients using the landmark technique.

3. People who were considered "difficult" to cannulate showed the most effect, and the effect shrank as the difficulty increased.

4. "Difficult" patients, ultrasound guidance may improve first-pass success of cannulation and overall success of cannulation, but did not appear to have a significant impact on patients' pain.

5. In 'moderately difficult' patients, ultrasound guiding likely boosted the cannulation's first-pass success, but there was no discernible impact on patients' pain. No research evaluated cannulation's overall effectiveness.

Reference: 

Tada, M., Yamada, N., Matsumoto, T., Takeda, C., Furukawa, T. A., & Watanabe, N. (2022a). Ultrasound guidance versus landmark method for peripheral venous cannulation in adults. Cochrane Database of Systematic Reviews, 12(12), CD013434. https://doi.org/10.1002/14651858.CD013434.pub2