studies have been performed analyzing the efficacy, speed, patency, and complications of ultrasound‐guided IV access. Across several inpatient and ED environments, ultrasound‐guided peripheral access shows trends toward being a comparable or preferable modality with regard to risk of failure, number of attempts, and procedure time [30]. There is clear demonstration of reduction of central line use when ultrasound is available to facilitate peripheral IV placement [31]. Success of ultrasound peripheral IV attempts was noninferior to the external jugular approach in those who failed traditional attempts [32].
With regard to prehospital use of this technology, barriers to implementation remain but are much less prominent than in previous years. Ultrasound machines remain expensive, and when accounting for rugged storage solutions, most devices require a nontrivial amount of physical space. Handheld ultrasound devices have been produced in recent years and may allow for feasibility studies of EMS‐initiated ultrasound‐facilitated IV access. As other applications for ultrasound are studied and implemented for prehospital use, the ability to gain vascular access may be an added benefit of the technology, even if not purchased for that primary purpose. As several other modalities are equivalent to if not faster than ultrasound‐guided peripheral IV placement, this technology may find a greater stronghold in alternative practice environments or in systems permissive of longer on‐scene times or for long‐distance or critical care transport (see Chapter 69).
Conclusion
Vascular access is a common procedure for EMS clinicians. In some cases it is to facilitate administration of needed medications or resuscitative fluids. In other cases, IVs are placed as a precautionary lifeline in case such measures are eventually needed. Many IVs are not used prior to arrival at an ED. It is important for EMS clinicians to possess the necessary skills and equipment to initiate vascular access under a myriad of conditions. Furthermore, this is an area that is appropriate for monitoring and evaluating from a quality improvement perspective, including both decision making and technical skill domains.
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