Difficult IV Access Clinical Trial
Official title:
Peripheral Internal Jugular Vein ('Peripheral IJ') Access in Patients Identified as Difficult Intravenous Access Research Study
The primary aim of this study is to determine if the insertion of a peripheral Internal Jugular (IJ) catheter is faster than a standard of care intravenous (IV)access in patients with difficult access. The secondary aims of this study examine patient discomfort between standard IV insertion vs. peripheral IV insertion as well as a comparison of complication rates between the two methods of insertion. Support for the peripheral IV procedure could provide an option for the thousands of Emergency Department (ED) patients who daily encounter the situation of difficult IV access and the numerous needle pokes that accompany it. Using this procedure may result in greater patient satisfaction and reduced complication rates.
This will be a randomized control trial comparing peripheral IJ to standard care of difficult
access patients.
1. Patients will be identified by nurses as having difficult IV access. This can be
determined based on past history or immediate experience. In other words, while a nurse
is caring for a patient, s/he might notice that the patient looks to have difficult
veins for an IV and may ask the patient 'Are you a hard stick?'. On the other hand, the
nurse may fail at a number of attempts at placing an IV. In both of the cases, the
patients can be determined to have difficult access and the nurse will have the option
to contact the research assistant or continue with current attempts.
2. Nurse will contact research assistant.
3. Research assistant (RA) will determine if the patient is being cared for by an MD with
appropriate experience for placing the peripheral IJ (attending, second or third year ED
resident).
4. RA will consent patient, discussing possible continuation of IV or IJ catheter
insertion. If patient agrees, he/she will be enrolled in the study.
5. Patient will be randomized.
6. Time clock will be started by RA when nurse or study member (attending physician, second
or third year resident) start the procedure (IV or IJ).
7. RA will monitor procedure progress and stop time clock when access has been confirmed by
study member or by nurse.
8. RA will survey patient regarding pain during procedure and satisfaction.
9. Patient chart will be queried at the completion of ED visit or hospitalization for
complications. Chart will be queried again at two weeks to evaluate for any return visit
complication.
Catheters will be placed by attending physicians and residents (2nd and 3rd years) with
experience placing ultrasound guided internal jugular central venous catheters. Because the
procedure is identical to the first step of placing an IJ Central Venous Catheter, there is
no special training needed for the procedure itself. A video will be created and viewed by
all placing the catheters to show the specifics so that there is standardization between
individuals.
Attempts to place the peripheral IJ will be limited to two. If not successful after two
attempts, the patient will return to 'standard care' and the treatment team will decide on
further directions such as ultrasound guided peripheral IV or central venous line.
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Status | Clinical Trial | Phase | |
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Completed |
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