Ultrasound-guided brachial and basilic vein cannulation in emergency department patients with difficult intravenous access.

STUDY OBJECTIVE Emergency department patients who require intravenous access but lack peripheral intravenous sites frequently require central line placement. Blind percutaneous brachial vein cannulation has been proposed as an alternative in these patients but is associated with high failure and complication rates. We evaluated an ultrasound-guided approach to percutaneous deep brachial vein or basilic vein cannulation in ED patients with difficult intravenous access. METHODS We prospectively enrolled ED patients who required intravenous access in whom there had been 2 unsuccessful attempts at establishing a peripheral intravenous line. Using a 7.5-MHz ultrasound probe, the deep brachial vein or basilic vein was identified and then cannulated with a 2-in, 18- to 20-gauge intravenous catheter. Time from probe placement to cannulation, number of attempts, and complications were recorded. RESULTS One hundred one patients were enrolled, of whom 50 were injection drug users and 21 were obese. Cannulation was successful in 91 patients (91%) and accomplished on the first attempt in 73 (73%). The mean (+/-SD) time required for cannulation was 77 seconds (+/-129, range 4 to 600 seconds). The line infiltrated or fell out within 1 hour of cannulation in 8 (8%) patients. One patient reported severe pain. There were 2 (2%) cases of brachial artery puncture. CONCLUSION Ultrasound-guided brachial and basilic vein cannulation is safe, rapid, and has a high success rate in ED patients with difficult peripheral intravenous access.