Evaluation of Success Rate of Ultrasound-Guided Venous Cannulation in Patients with Difficult Venous Access

Background/Objective: We evaluated a new ultrasound-guided approach to percutaneous cephalic vein or basilic vein cannulation in patients with difficult intravenous access. Patients and Methods: Patients who required intravenous access and were candidates for surgical approach, or central venous catheterization were enrolled into the study. They had at least three unsuccessful attempts at establishing a peripheral intravenous line. By using a 7.5-MHz ultrasound probe, the cephalic or basilic vein was identified and then cannulated with a conventional venous cannula. The time from probe placement to cannulation, the number of attempts and complications were recorded. Results: Eighty-eight patients were enrolled; 28 (31.8%) female and 60 (68.2%) male. The intravenous (IV) drug abusers consisted of 29 patients (33%) which were all men (48% of males). The procedure was successful in 94.3% and failed in five cases (5.7%) after three attempts. The mean time of procedure was 175±153 seconds. There was a significant difference between IV drug abusers (231±203) and non IV drug abusers (149±118) regarding access time (p-value=0.012). The procedure was successful after one attempt in 61 patients (73.5%), two attempts in 20 patients (24.1%) and three attempts in two patients (2.4%). The cannula was dislodged in three cases after one hour of follow-up. No other complications happened. Conclusion: Ultrasound-guided cephalic and basilic vein cannulation is safe and time saving, has a high success rate in patients with difficult peripheral intravenous access, and may be used as the first step in these patients before the other more invasive alternatives.