Written by Chris Thom
Spoon Feed
This RCT demonstrated no difference in success rates of ultrasound-guided peripheral IV (USGIV) placement between traditional cart-based and handheld ultrasound devices.
Handhelds are effective for USGIV
Adult patients with two failed attempts at traditional palpation IV were eligible for enrollment. USGIV attempts were randomized to be performed using a GE Vscan Air (handheld) or a SonoSite device (cart-based). Operators placing USGIVs included any ED physician or any ancillary staff members with appropriate training. Outcomes evaluated were placement success, first attempt success rate, and USGIV survival rate. 312 unique USGIV placements were enrolled, with 156 randomized to the control group and 156 to the intervention group. There were no statistically significant differences between groups in terms of age, ESRD, obesity, or history of IVDA. There were also no differences in USGIV gauge or operator type between groups. 97% of USGIVs were successfully placed in both the handheld group and cart-based group (p>0.9). 85% of USGIVs had first attempt success in the handheld group, with 84% success in the cart-based group (p=0.8). Premature failure rates of the USGIV were similar in both groups as well.
How will this change my practice?
Handheld ultrasound devices keep getting better. Given the size and portability advantages, handheld devices might be particularly well suited for USGIV purposes. The caveat is that only one handheld US device was studied (GE VScan Air), and it may have higher image quality than some comparator handheld devices. In addition, the SonoSite cart-based cohort included modern devices (SonoSite PX), but also devices that are > 15 years out of date (M-turbo), which limits the conclusions. In addition, deeper needle guided procedures (e.g. – regional anesthesia) might benefit from the increased image quality of a modern cart-based device, so I would limit conclusions to IV placement.
Pro-tips and clips
The USGIV skillset is key for emergency medicine and critical care physicians. USGIV is the premier way to improve your ultrasound-guided needling skills. If you can place a tricky USGIV, arterial lines, central lines, arthrocentesis, and regional anesthesia will be much easier. I recommend this video from the SAEM AEUS, which provides an excellent tutorial for USGIV placement.
Source
Handheld ultrasound versus standard machines for placement of peripheral IV catheters: A randomized, non-inferiority study. Am J Emerg Med. 2025 Jan;87:32-37. doi: 10.1016/j.ajem.2024.10.036. Epub 2024 Oct 24. PMID: 39471523.
