Critical Appraisal Guidelines: Qualitative - Part 2
Amanda T. Creel
Grand Canyon University: NRS – 433V
June 9, 2013

The research article reviewed was “Ultrasound – Guided Peripheral Venous Access vs. the External Jugular Vein as the Initial Approach to the Patient with Difficult Vascular Access” by T.G. Costantino MD, J. F. Kirtz MD, and W. A. Satz MD. Intravenous (IV) access is commonly performed in the Emergency Department (ED). In patients with difficult access, physicians are frequently called upon to perform these procedures. Physicians should be familiar with both the external jugular (EJ) IV technique and the ultrasound – guided IV (USIV) peripheral access techniques. Some hospitals have specialized team of nurses that have been educated and trained on the proper way to establish an EJ IV and/or USIV. This study examined both techniques and collected data to establish which techniques was better for the patient.
Protection of Human Participants
Risks and Benefits Addressed by the Authors The benefit of this study was to spare the ED patient with difficult veins from having to receive a central venous line. The infection rate is higher in a central line than a peripheral IV line. The use of USIV will also decrease the number or IV attempts instead of a central line. While this decreased the actual number of IV attempts, it still had some risks. One major risk is arterial punctures. The other risks include nerve irritation and hematomas at the site of both USIV and EJ IV attempts.
Consents and Approvals The study was approved by the university’s institutional review board of an urban, tertiary – care university hospital ED. The subjects entered the study voluntarily after being education on the research. After the education process, a written consent was obtained. The patient was then placed in a randomized tract of the study.
Data Collection The study has 2 variables in which data was collected. The 2 variables included USIV and EJ IV. The study had 2 inclusion criteria: age must be greater than 18 years of age and 3 failed IV attempts. The need for a central line and the inability to give consent were the exclusions. The data was collected through a non – blinded randomized study of ED patients in need of IV access and how much time it took to establish access. The study included 32 patients that received an USIV and 28 patients that an EJ IV was obtained. The EJ IVs and the USIVs were established by 2nd and 3rd year medical residents that were trained in USIV. The study was conducted in the ED only from June 2007 to December 2007. The data collection began with the first IV attempt and ended with the successful cannulation of either the USIV or EJ IV. The rationale of the study was to show which technique is more commonly successful as the first approach to the patient with difficult intravenous access.
Data Management and Analysis
Methods Used in Study The data analysis used in the study was based on outcome measures. The author based the success of cannulation on the presence of 5 mL blood and a patent IV line that infuses easily. Data collected was grouped into 6 different areas. The areas included the number of successfully placed IVs, number of successful IVs obtain in each technique, amount of time it took to place the IV, length of stay in the ED, average number or total sticks, and any complication observed while in the ED.

Process of Study The development of the study was validated by the successful cannulation of a peripheral by using either USIV or EJ IV techniques. The data is collected and analyzed through memos, notes, tables and diagrams. The study included 3 tables and 1 diagram including the data obtained. The author did not state if statistical software was used during the study. The results were displayed in the hypothesis testing form while using a p – value