The following is a summary of “Mono- and bi-plane sonographic approach for difficult accesses in the emergency department – A randomized trial,” published in the December 2023 issue of Emergency Medicine by Baion, et al.

Inserting peripheral intravenous (PIV) catheters is a common invasive procedure in acute healthcare settings, but peripheral vascular access (PDVA) can lead to delays in medication administration. Ultrasound (US) has become valuable for PIV cannulation, with bi-plane imaging offering simultaneous longitudinal and transverse vessel views. For a study, researchers sought to assess if bi-plane imaging provided better outcomes for PDVA in the emergency department (ED) than the single-plane approach.

The single-center randomized controlled trial enrolled adult ED patients needing PIV cannulation. Patients were randomly assigned to mono-plane or bi-plane cannulation, performed by skilled providers. The primary outcome was the first attempt success rate.

Of 442 patients, 221 underwent mono-plane cannulation. Successful PIV catheter placement on the first attempt occurred in 313 patients (70.8%). Success rates were comparable between groups: 68.3% in the mono-plane and 73.3% in the bi-plane group (P = 0.395). The median time for successful attempts differed: 45 s (range 18–600) in mono-plane vs. 35 s (range 20–600) in bi-plane (P = 0.03).

US is effective for PIV cannulation in PDVA patients in the ED, but bi-plane imaging did not significantly improve outcomes compared to mono-plane imaging.

Reference: sciencedirect.com/science/article/abs/pii/S0735675723004862