Background: U/S-guided IV access is frequently required for difficult access emergency care patients. Establishing an IV can be challenging and involve significant time, multiple attempts, and delays in care. The double tourniquet technique is a method that distends the vein and may improve first-stick insertion success.
Methods: This was a prospective, randomized comparative evaluation of difficult access ED patients requiring U/S-guided IV catheter placements. Patients were randomized to receive a single tourniquet proximal to needle insertion site or a double tourniquet proximal and distal to the needle insertion site. The primary outcome was first-stick success. Data collection included: provider type (faculty or non-faculty: resident, nurse, technician), patient characteristics (medical history, body mass index) and insertion characteristics (access site, vein depth and diameter). Statistical comparisons were made using Chi-squared tests and Fisher’s exact test. All tests of statistical significance were two-sided with a p-value < 0.05 indicating significant difference.
Results: 100 patients were enrolled based on feasibility with 50 patients in each group. Ultimately 40 patients in the single tourniquet group and 43 patients in the double tourniquet cohort were included in the data analysis. Seventeen patients in the original enrollment were lost due to malfunction of U/S equipment data storage. First-stick success was 77.5% in the single tourniquet group and 76.7% in the double tourniquet group. (p=0.93). Faculty first stick success for either technique was 94.7% compared to 62.2% for non-faculty first stick success
Conclusions: Use of single versus double tourniquet technique does not impact first-stick success for U/S-guided IV insertion. Faculty inserters had higher overall first-stick success compared to non-faculty inserters independent of tourniquet method utilized.