Читать книгу Emergency Medical Services - Группа авторов - Страница 217

In ED care, ultrasound technology has become a useful tool to improve IV access success. Previously, patients who were unable to be cannulated by more traditional methods were often subject to more invasive procedures such as cutdowns or central lines, posing an increased level of risk. The growing widespread availability of ultrasound technology has found a role to augment the ability of clinicians to obtain IV access in a less‐invasive fashion. While a detailed instruction is beyond the scope of this text, ultrasound techniques can be used in a static fashion to identify the location of a suitable vein when one cannot be seen or palpated. The vein is then accessed by the usual techniques. Alternatively, a dynamic approach is often used, wherein the clinician uses ultrasound to visualize the needle tip and subsequently the catheter entering the vein, confirming placement. The materials and methods are largely similar to standard peripheral access techniques, with the exception of the need for an ultrasound machine, gel, and longer length catheters for accessing deeper veins.

Multiple studies have been performed analyzing the efficacy, speed, patency, and complications of ultrasound‐guided IV access. Across several inpatient and ED environments, ultrasound‐guided peripheral access shows trends toward being a comparable or preferable modality with regard to risk of failure, number of attempts, and procedure time [30]. There is clear demonstration of reduction of central line use when ultrasound is available to facilitate peripheral IV placement [31]. Success of ultrasound peripheral IV attempts was noninferior to the external jugular approach in those who failed traditional attempts [32].

With regard to prehospital use of this technology, barriers to implementation remain but are much less prominent than in previous years. Ultrasound machines remain expensive, and when accounting for rugged storage solutions, most devices require a nontrivial amount of physical space. Handheld ultrasound devices have been produced in recent years and may allow for feasibility studies of EMS‐initiated ultrasound‐facilitated IV access. As other applications for ultrasound are studied and implemented for prehospital use, the ability to gain vascular access may be an added benefit of the technology, even if not purchased for that primary purpose. As several other modalities are equivalent to if not faster than ultrasound‐guided peripheral IV placement, this technology may find a greater stronghold in alternative practice environments or in systems permissive of longer on‐scene times or for long‐distance or critical care transport (see Chapter 69).