Choosing a venodilatation method in hypotensive patients
Abstract:
Objectives: Peripheral intravenous catheterization (PIVC) is one of the most common invasive procedures performed in emergency departments (EDs). Elastic tourniquets (ET) and blood pressure cuffs (BPC) are most commonly used for venodilatation. Difficult vascular access can be predicted in some patients, and the rate of successful first-time PIVC placement in this group is low. In this study, we investigated which venodilatation method is most appropriate for hypotensive patients, a group in whom vascular access is predicted to be difficult.
Methods: This was a prospective, single-blind, randomized controlled trial in the ED of a tertiary care hospital. Hypotensive patients were randomly assigned to two methods of administration. Patients’ basilic vein diameters and venous collapsibility were measured before and after the intervention by a physician blinded to the intervention, followed by intravenous (IV) access. The primary outcome was the change in basilic vein diameter after the applied venodilatation method (ET or BPC), and the secondary outcomes were the change in vein collapsibility and initial access success rate.
Results: In this study of 101 patients, basilic vein diameter increased from 4.05 to 5.4 mm in the BPC group and from 4.1 to 4.5 mm in the ET group. The change in diameter in the BPC group was greater than that in the ET group (p < .0001). In addition, IV access was successful in 33 (63%) of 52 patients in the BPC group on the first attempt and in 20 (41%) of 49 patients in the ET group. The change in collapsibility was greater in the BPC group after the procedure.
Conclusion: BPC during PIVC insertion in hypotensive patients presenting to the ED showed both a greater increase in basilic vein diameter and superior initial access success than ET. Therefore, we recommend BPC as a method of venodilatation in hypotensive patients.
Reference:
Şirin İ, Uysal ŞB, Kayıpmaz AE. Comparison of Elastic Tourniquet and Blood Pressure Cuff for Peripheral Intravenous Access in Hypotensive Patients: A Randomized Single-Blind Study. J Emerg Med. 2025 Jul 8;76:41-49. doi: 10.1016/j.jemermed.2025.07.004. Epub ahead of print. PMID: 40779993.