Can we make the basilic vein larger? maneuvers to facilitate ultrasound guided peripheral intravenous access: a prospective cross-sectional study
1 Department of Epidemiology and Prevention, Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
2 Department of Emergency Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
3 Department of Anesthesiology, The University of Texas School of Medicine San Antonio, San Antonio, TX, USA
4 Department of Emergency Medicine, John Peter Smith Health Network, Fort Worth, TX, USA
5 Department of Emergency Medicine, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, USA
International Journal of Emergency Medicine 2011, 4:53 doi:10.1186/1865-1380-4-53Published: 25 August 2011
Studies have shown that vein size is an important predictor of successful ultrasound-guided vascular access. The objective of this study is to evaluate maneuvers designed to increase basilic vein size, which could be used to facilitate ultrasound-guided peripheral intravenous access (USGPIV) in the Emergency Department (ED) setting.
This was a prospective non-randomized trial. Healthy volunteers aged 18-65 were enrolled. Basilic veins were identified and the cross-sectional area measured sonographically. Following baseline measurement, the following maneuvers were performed: application of a tourniquet, inflation of a blood pressure (BP) cuff, application of a tourniquet with the arm lowered, and BP cuff inflation with the arm lowered. Following each maneuver there was 30 s of recovery time, and a baseline measurement was repeated to ensure that the vein had returned to baseline. Change in basilic vein size was modeled using mixed model analysis with a Tukey correction for multiple comparisons to determine if significant differences existed between different maneuvers.
Over the 5-month study period, 96 basilic veins were assessed from 52 volunteers. All of the maneuvers resulted in a statistically significant increase in basilic vein size from baseline (p < 0.001). BP cuff inflation had the greatest increase in vein size from baseline 17%, 0.87 mm 95% CI (0.70-1.04). BP cuff inflation statistically significantly increased vein size compared to tourniquet placement by 3%, 0.16 mm 95% CI (0.02-0.30).
The largest increase in basilic vein size was due to blood pressure cuff inflation. BP cuff inflation resulted in a statistically significant increase in vein size compared to tourniquet application, but this difference may not be clinically significant.