Effectiveness of venous transillumination on peripheral venous line placement in emergency departments patients with difficult vascular access: a multicentre cluster-randomised trial.

Background and importance: Peripheral venous line placement is an essential procedure, but sometimes technically complex in emergency departments, particularly among patients with difficult vascular access. First-attempt failure rates are a commonly reported adverse event. Alternative procedures, such as ultrasound-guided peripheral venous line placement, require specialised training and resources, thus limiting their feasibility in urgent settings.

Objective: This trial evaluated the effectiveness of a venous transillumination device compared with the usual method.

Design, settings, and participants: This was a prospective, multicentre, cluster-randomised, and open-label study conducted across three hospitals in France between December 2021 and July 2023. Patients aged greater than or equal to18 years were included if they met at least one of nine predefined criteria for difficult vascular access: extreme BMI; hypotension; nonsupportive environment (e.g. poor lighting, incarceration, and external temperature <3 °C); history of drug abuse; limited venous capital (e.g. chemotherapy, long-term corticosteroid use, and radiotherapy); restricted puncture sites (e.g. arteriovenous fistula, hemiplegia, skin lesions, lymph node dissection, and postmastectomy); dehydration; generalised oedema; and hypothermia.

Interventions: Participants were allocated to either the venous transillumination device group (intervention) or the usual method group (control) based on the week of inclusion.

Outcome measures and analysis: The primary outcome was the percentage of first-attempt success rate. The secondary outcomes included the number of attempts before success, patients' pain, and nurses' stress levels.

Main results: A total of 401 patients were included (181 in the control group and 220 in the intervention group). Median age was 62 (43-76), and 62% were women. Compared with the control group, the first-attempt success rate was significantly higher in the venous transillumination group: 70 vs. 41% [difference in percentage 29% (28 - 30%); P < 0.001]. The median number of attempts before success was lower [0.0 (0.0-1.0) vs. 1.0 (0.0-2.0); P < 0.001]. Patients' pain and nurses' stress scores did not differ between groups.

Conclusion: In this study, the use venous transillumination device was associated to a significant improvement of the first-attempt success rate of peripheral venous line placement in patients with difficult access.