Authors: Adrienne N Malik, Stephanie Thom, Travis Helberg, Bradley S Jackson, Nima Sarani, Melissa Thomas, Matthew Cook, Dana Thompson, Austin Petz, Magen Gunsolley, Robert R Ehrman
Journal: American Journal of Emergency Medicine, 2024 October 24
Conclusion:
HHU was noninferior to CBUS for USGIV placement success, first attempt success rate, and IV survival to ED discharge. The HHUs required no additional training for ED providers, making them a feasible, efficient alternative to CBUS for routine IV placements in the ED setting.
Methods:
In this randomized, noninferiority trial, ED patients aged 18 and older who required USGIV were randomized to receive IV placement using either CBUS or HHU. Placement was performed by trained ED physicians or nurses, and success was defined as immediate IV flushability with saline. Data were collected on placement success, number of attempts, patient demographics, IV characteristics, and duration of IV patency. Statistical analyses included Pearson's Chi-square, Fischer's Exact test, or Wilcoxon rank sum tests, with noninferiority assessed using the Farrington-Manning test.
Results:
A total of 312 patients were enrolled, with comparable patient and IV characteristics across groups. Successful USGIV placements were achieved in 146 patients in the CBUS group and 145 in the HHU group (p≥0.9), with no significant difference in first attempt success rate (p = 0.8). The HHU was confirmed as noninferior to CBUS for USGIV placement (p = 0.0001). Premature IV failure rates were similar for HHU and CBUS (4.0% vs. 6.7%).