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Hosseini SJ, Firooz M, Yazdi K, Abdollahi M, Hosseini SR, Ramezani M. The efficacy of technology-based devices on the first-attempt success rate for difficult intravenous access in pediatrics: A systematic review and network meta-analysis. J Vasc Access 2024:11297298241259843. [PMID: 38884338 DOI: 10.1177/11297298241259843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024] Open
Abstract
INTRODUCTION Previous studies have compared various technology-based devices, such as ultrasonography (USG), near-infrared (NIR), and transilluminator (TI), with standard care (SC) to facilitate peripheral intravenous cannulation (PIVC) in pediatric patients. This study aims to investigate the efficacy of these interventions on the first-attempt success rate (FASR) of PIVC in pediatric patients with difficult intravenous access (DIVA) using network meta-analysis (NMA). METHODS We conducted a comprehensive literature search in databases to identify randomized clinical trials comparing the effects of different devices on the FASR of PIVC from inception until August 2023. Pooled relative risks with 95% credible intervals were estimated using pairwise and network meta-analysis with random effects. To rank the efficacy of devices, we calculated the probabilities of the surface under the cumulative ranking curve (SUCRA). RESULTS A total of 18 studies were included in the final analysis. The results of pairwise meta-analysis showed that the use of devices increased the FASR for PIVC by 13% (RR: 1.13, 95% CI: [0.98, 1.30]) compared to SC. The ranking of interventions based on efficacy from highest to lowest was as follows: USG (SUCRA: 1), NIR (SUCRA: 0.6), SC (SUCRA: 0.3), and TI (SUCRA: 0.1), with a very low confidence estimate. CONCLUSION Based on our findings, the prioritization of device usage to increase the FASR of PIVC in pediatric patients with DIVA is as follows: USG, NIR, SC, and TI, respectively. However, due to inconsistencies in the network, existence of an overall high risk of bias in the included studies, and very low confidence estimate, further clinical trials are required.
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Affiliation(s)
| | - Mahbobeh Firooz
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran
| | - Khadijeh Yazdi
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran
| | - Masoud Abdollahi
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Reza Hosseini
- Department of Emergency Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Monir Ramezani
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Garcia-Castrillo L, Cadamuro J, Dodt C, Lauwaert D, Hachimi-Idrissi S, Van Der Linden C, Bergs J, Costelloe S, Grossmann F, Koca A, Palomäki A, Ruiz JL, Stonys R, Thorsteinsdottir TK, von Meyer A, Vermeersch P, Abellas Alvarez MC, Eker P, Golea A, Kurland L, Lippi G, Zhilenkova Y, Sehmi K. Recommendations for blood sampling in emergency departments from the European Society for Emergency Medicine (EUSEM), European Society for Emergency Nursing (EuSEN), and European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for the Preanalytical Phase. Executive summary. Clin Chem Lab Med 2024; 0:cclm-2024-0059. [PMID: 38581294 DOI: 10.1515/cclm-2024-0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 04/08/2024]
Abstract
AIM Blood Sampling Guidelines have been developed to target European emergency medicine-related professionals involved in the blood sampling process (e.g. physicians, nurses, phlebotomists working in the ED), as well as laboratory physicians and other related professionals. The guidelines population focus on adult patients. The development of these blood sampling guidelines for the ED setting is based on the collaboration of three European scientific societies that have a role to play in the preanalytical phase process: EuSEN, EFLM, and EUSEM. The elaboration of the questions was done using the PICO procedure, literature search and appraisal was based on the GRADE methodology. The final recommendations were reviewed by an international multidisciplinary external review group. RESULTS The document includes the elaborated recommendations for the selected sixteen questions. Three in pre-sampling, eight regarding sampling, three post-sampling, and two focus on quality assurance. In general, the quality of the evidence is very low, and the strength of the recommendation in all the questions has been rated as weak. The working group in four questions elaborate the recommendations, based mainly on group experience, rating as good practice. CONCLUSIONS The multidisciplinary working group was considered one of the major contributors to this guideline. The lack of quality information highlights the need for research in this area of the patient care process. The peculiarities of the emergency medical areas need specific considerations to minimise the possibility of errors in the preanalytical phase.
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Affiliation(s)
- Luis Garcia-Castrillo
- Emergency Department, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christoph Dodt
- Emergency Department, Universitair Ziekenhuis Brussels, Brussels, Belgium
| | - Door Lauwaert
- München Klinik gGmbH, Clinic for Acute and Emergency Care, Munich, Germany
| | - Said Hachimi-Idrissi
- Universiteit Gent Faculteit Geneeskunde en Gezondheidswetenschappen, Emergency Medicine, Gent, Belgium
- Universitair Ziekenhuis Gent, Emergency Medicine, Gent, Belgium
| | | | - Jochen Bergs
- Faculty of Medicine and Life Sciences, Research Group Healthcare & Ethics, Hasselt University, Limburg, Belgium
- Department of Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Netherlands
| | - Sean Costelloe
- Department of Clinical Biochemistry, Cork University Hospital Group, Cork, Ireland
| | | | - Ayca Koca
- Department of Emergency Medicine, Ankara University School of Medicine, Ankara, Türkiye
| | - Ari Palomäki
- Kanta-Häme Central Hospital, Tampere Universities, Hämeenlinna, Finland
| | - Jose Luis Ruiz
- Emergency Department, Hospital Universitario de La Ribera, Valenciana, Spain
| | - Ricardas Stonys
- Center of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | | | - Pieter Vermeersch
- KU Leuven University Hospitals Leuven, Laboratory Medicine, Leuven, Belgium
| | | | - Pinar Eker
- Biochemistry and Clinical Biochemistry, Maltepe Universitesi Tip Fakultesi, Istanbul, Türkiye
| | - Adela Golea
- Emergency Department, Cluj-Napoca County Emergency Hospital, Cluj-Napoca, Romania
| | - Lisa Kurland
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, Universita degli Studi di Verona, Verona, Italy
| | - Yulia Zhilenkova
- Department of Laboratory Medicine and Genetics, Almazov National Medical Research Centre, Sankt-Peterburg, Russia
| | - Kawaldip Sehmi
- International Alliance of Patients' Organizations, London, UK
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Álvarez-Morales L, Gómez-Urquiza JL, Suleiman-Martos N, Membrive-Jiménez MJ, González-Díaz A, García Pérez R, Liñán-Gonzalez A. Ultrasound-guided peripheral intravenous canulation by emergency nurses: A systematic review and meta-analysis. Int Emerg Nurs 2024; 73:101422. [PMID: 38401479 DOI: 10.1016/j.ienj.2024.101422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/05/2024] [Accepted: 02/01/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Peripheral intravenous cannulation is a common procedure in the emergency department. Nevertheless, failure rates during the first attempt are as high as 40% in adults and 65% in children. Evidence suggests that physician performed ultrasound-guided peripheral intravenous cannulation (USG-PIVC) is an effective alternative to the traditional method; however, there is insufficient data on the efficacy of the technique performed by nurses. OBJECTIVE To examine the efficacy of the USG-PIVC technique performed by emergency department nurses. METHODS A literature review with meta-analysis was performed. The databases used were PubMed, Scopus and CINAHL. The search was conducted in March 2023. Two meta-analysis one of clinical trials about the effectiveness and one about the succession rate were performed. RESULTS 20 studies were selected and analysed. The studies showed that USGPIVC performed by emergency nurses increased the probability of both the overall success and a successful first attempt compared to the standard technique. In addition, patients showed high satisfaction and lower complication rates. However, the procedure had no significant effect on the time or number of attempts required. A lower probability of success was obtained as regards peripheral intravenous cannulation when the standard technique was used, OR = 0.42 (95 %CI 0.25-0.70p < 0,05). CONCLUSIONS Ultrasound-guided peripheral intravenous cannulation performed by emergency nurses is a safe and effective technique.
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Affiliation(s)
- Lorena Álvarez-Morales
- Faculty of Health Sciences, University of Granada, 18016, Conocimiento Avenue, Granada, Spain
| | - José L Gómez-Urquiza
- Ceuta Faculty of Health Sciences, University of Granada, Cortadura del Valle s/n, 51001 Ceuta, Spain.
| | - Nora Suleiman-Martos
- Faculty of Health Sciences, University of Granada, 18016, Conocimiento Avenue, Granada, Spain
| | | | - Ana González-Díaz
- Ceuta Faculty of Health Sciences, University of Granada, Cortadura del Valle s/n, 51001 Ceuta, Spain
| | - Raquel García Pérez
- Faculty of Health Sciences, University of Granada, 18016, Conocimiento Avenue, Granada, Spain
| | - Antonio Liñán-Gonzalez
- Melilla Faculty of Health Sciences, University of Granada, Santader St., 52005 Melilla, Spain
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Sekiguchi S, Moriyama K, Tokumine J, Lefor AK, Nakazawa H, Tomita Y, Yorozu T. Near-infrared venous imaging may be more useful than ultrasound guidance for novices to obtain difficult peripheral venous access: A crossover simulation study. Medicine (Baltimore) 2023; 102:e33320. [PMID: 36961182 PMCID: PMC10036034 DOI: 10.1097/md.0000000000033320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/28/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Difficult peripheral venous access, especially in obese people, is challenging for novices. We conducted a randomized cross-over study to examine whether near-infrared venous imaging or ultrasound guidance is more useful for novice operators to obtain difficult peripheral venous access. METHODS Medical students were recruited as participants. After receiving basic training using commercial simulators, participants were randomly assigned to obtain simulated venous access using a difficult venous access simulator with near-infrared venous imaging or ultrasound guidance in a randomized cross-over design. A difficult venous access simulator was newly developed with deep and narrow vessels to simulate an obese patient. The primary outcome measure of the study was the first-time success rate (%), and the secondary outcome measures included procedure time (seconds) and the number of 3 consecutive successful attempts, to represent proficiency with the procedure. Pearson chi-square test, the Wilcoxon signed-rank test, and generalized estimating equations were used for statistical analysis. RESULTS Forty-one medical students with no experience performing peripheral venous access were enrolled in this study. The rate of successful first attempts did not differ between the 2 groups (70% for near-infrared; 65% for ultrasound guidance; P = .64). The duration of the procedure for the first attempt was significantly shorter using near-infrared imaging (median: 14; interquartile range: 12-19) compared to ultrasound guidance (median 46; interquartile range: 26-52; P = .007). The number of attempts until 3 consecutive successes was not significantly different comparing the 2 approaches (near-infrared: 3 (3, 7.25), ultrasound guidance: 3 (3, 6.25), P = .63). CONCLUSION There was no difference in success rate of first-time attempts or acquiring proficiency for the 2 methods. However, duration of the first attempt was significantly shorter with near-infrared imaging than with ultrasound guidance. Near-infrared imaging may require less training than ultrasound guidance. Near-infrared venous imaging may be useful for novices to obtain difficult peripheral venous access in obese patients.
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Affiliation(s)
- Shinichiro Sekiguchi
- Department of Medical Education, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Kiyoshi Moriyama
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Joho Tokumine
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Harumasa Nakazawa
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Yasuhiko Tomita
- Department of Medical Education, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Tomoko Yorozu
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
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Berlanga-Macías C, Díez-Fernández A, Martínez-Hortelano JA, Sequí-Domínguez I, Saz-Lara A, Pozuelo-Carrascosa D, Martínez-Vizcaíno V. Ultrasound-guided versus traditional method for peripheral venous access: an umbrella review. BMC Nurs 2022; 21:307. [DOI: 10.1186/s12912-022-01077-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
Short peripheral catheters (SPC) insertion technique has a high failure rate, one of the reasons why the ultrasound (US)-guided method has been proposed as a valid alternative to traditional technique in SPC insertion. This umbrella review aims to synthesize the available evidence comparing the US-guided method with the traditional method on SPC insertion in terms of effectiveness, safety and patient satisfaction.
Methods
An umbrella review addressing the comparison between US-guided versus traditional method for SPC insertion in which only systematic reviews of all comparative study designs were eligible was carried out. Previous systematic reviews and meta-analyses were systematically searched in MEDLINE, EMBASE, Web of Science and Cochrane Library. Methodological quality was assessed with AMSTAR-2 tool. The quality of evidence per association was assessed using the GRADE criteria and was stablished as high, moderate, low and very low.
Results
Twelve systematic reviews with a range of 75–1860 patients were included. Moderate certainty evidence supports the positive effect of US-guided method on first-attempt success rate and number of attempts. There is moderate certainty evidence that US-guided method does not reduce the time spent in SPC insertion. Low certainty evidence supports that US-guided method improves both overall success rates and patient satisfaction. Emergency department was the main hospital department where these findings were reported.
Conclusions
The best current evidence indicates that US-guided method for SPC insertion is postulated as a valid alternative for both adult and pediatric population, especially in patients with difficult venous access and in hospital departments where optimal vascular access in the shortest time possible is critical.
Trial registration
PROSPERO: CRD42021290824.
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Ienghong K, Cheung LW, Tiamkao S, Bhudhisawasdi V, Apiratwarakul K. The Utilization of Handheld Ultrasound Devices in a Prehospital Setting. Prehosp Disaster Med 2022; 37:355-359. [PMID: 35435155 PMCID: PMC9118051 DOI: 10.1017/s1049023x22000644] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/22/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Prehospital ultrasounds can be considered a new form of diagnostic tool when taking into account their small structure and due to the fact that nowadays, they are used in the care of emergency patients. However, at present, there is no study regarding the advantage of ultrasound usage in prehospital settings in Thailand. STUDY OBJECTIVE This study aims to determine the sonographic characteristics recorded by handheld ultrasounds used in prehospital care and the diagnostic accuracy of ultrasounds for prehospital patients. METHODS A cross-sectional study was conducted on prehospital patients who underwent point-of-care ultrasound (POCUS) examination on Emergency Medical Service (EMS) operations at Srinagarind Hospital, Thailand from January 2021 through December 2021. The ultrasound images, the electronic emergency department medical records, and the EMS database were recorded and reviewed by a team of emergency physicians. The quality of prehospital ultrasound examinations was assessed by comparing the diagnoses at the scene with those taken at the hospital. RESULTS One hundred sixty-nine prehospital patients who received POCUS examinations were examined over a one-year period. All (100.0%) of the scans were for medical cases. No ultrasound protocol was used in the prehospital care. Two hundred eight POCUS examinations were performed in this study. The most common POCUS indication was dyspnea (45.6%), followed by hypotension/shock (30.1%), and finally syncope (8.2%). The most common area where POCUS was performed was on the lung (37.0%), followed by the inferior vena cava (30.8%), and finally for cardiac cases (26.4%). This study found that 34.9% of sonographic findings could be considered abnormal. The diagnoses of prehospital patients were confirmed by using POCUS in 66 cases (39.1%) with the accuracy of prehospital diagnosis reaching a peak of 75.8%. CONCLUSION This study shows POCUS examinations can be effectively used in prehospital care. The prehospital diagnosis given by physicians administering treatment who used POCUS examinations correlated with the in-hospital diagnosis.
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Affiliation(s)
- Kamonwon Ienghong
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Lap Woon Cheung
- Accident & Emergency Department, Princess Margaret Hospital, Kowloon, Hong Kong
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Somsak Tiamkao
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Korakot Apiratwarakul
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Takahashi T, Nakagami G, Murayama R, Abe-Doi M, Matsumoto M, Sanada H. Automatic vein measurement by ultrasonography to prevent peripheral intravenous catheter failure for clinical practice using artificial intelligence: development and evaluation study of an automatic detection method based on deep learning. BMJ Open 2022; 12:e051466. [PMID: 35613784 PMCID: PMC9174762 DOI: 10.1136/bmjopen-2021-051466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Complications due to peripheral intravenous catheters (PIVC) can be assessed using ultrasound imaging; however, it is not routinely conducted due to the need for training in image reading techniques. This study aimed to develop and validate a system that automatically measures blood vessel diameters on ultrasound images using artificial intelligence (AI) and provide recommendations for selecting an implantation site. DESIGN Pilot study. SETTING The University of Tokyo Hospital, Japan. PRIMARY AND SECONDARY OUTCOME MEASURES First, based on previous studies, the vessel diameter was calculated as the mean value of the maximum long diameter plus the maximum short diameter orthogonal to it. Second, the size of the PIVC to be recommended was evaluated based on previous studies. For the development and validation of an automatic detection tool, we used a fully convoluted network for automatic estimation of vein location and diameter. The agreement between manually generated correct data and automatically estimated data was assessed using Pearson's product correlation coefficient, systematic error was identified using the Bland-Altman plot, and agreement between catheter sizes recommended by the research nurse and those recommended by the system was evaluated. RESULTS Through supervised machine learning, automated determination was performed using 998 ultrasound images, of which 739 and 259 were used as the training and test data set, respectively. There were 24 false-negatives indicating no arteries detected and 178 true-positives indicating correct detection. Correlation of the results between the system and the nurse was calculated from the 178 images detected (r=0.843); no systematic error was identified. The agreement between the sizes of the PIVC recommended by the research nurse and the system was 70.2%; 7% were underestimated and 21.9% were overestimated. CONCLUSIONS Our automated AI-based image processing system may aid nurses in assessing peripheral veins using ultrasound images for catheterisation; however, further studies are still warranted.t.
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Affiliation(s)
- Toshiaki Takahashi
- Department of Gerontological Nursing/Wound Care Management, The University of Tokyo, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, The University of Tokyo, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryoko Murayama
- Research Center for Implementation Nursing Science Initiative, Reseach Promotion Headquarters, Fujita Health University, Aichi, Japan
| | - Mari Abe-Doi
- Department of Gerontological Nursing/Wound Care Management, The University of Tokyo, Tokyo, Japan
| | | | - Hiromi Sanada
- Ishikawa Prefectural Nursing University, Ishikawa, Japan
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