“Peripheral intravenous catheters are commonly placed in the emergency department, with up to 10% of patients being considered to have difficult vascular access via the landmark-based approach. Ultrasound can be used to directly visualize the vessels and guide PIV placement in real time by a variety of healthcare professionals (e.g., physicians, nurses, paramedics). One recent meta-analysis found that ultrasound guidance improved the first-pass success rate (75.8% vs. 65.5%; number-needed-to-treat: 10) and overall success rate (87.2% vs. 68.7%; number-needed-to-treat: 6). The benefit was most pronounced in the patients with difficult access, followed by those with moderate access. Interestingly, those with easy access by the landmark approach had a lower first-pass success rate. This may be due to the high success rates already present with the landmark approach, easier compression of superficial vessels under the weight of the ultrasound probe, or difficulty with threading the PIV in shallow vessels. This suggests the greatest utility of ultrasound guidance for PIVs is in patients with average or difficult vascular access”.

Gottlieb M, Schraft EK, O’Brien JR, Kim DJ. Just the facts: ultrasound-guided peripheral intravenous catheter placement. CJEM. 2023 Jun 10. doi: 10.1007/s43678-023-00540-z. Epub ahead of print. PMID: 37300654.