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The following is a summary of “Handheld ultrasound versus standard machines for placement of peripheral IV catheters: A randomized, non-inferiority study,” published in the January 2025 issue of Emergency Medicine by Malik et al. 

Handheld ultrasounds (HHUs) may serve as an alternative to cart-based ultrasound systems (CBUS) for ultrasound-guided IV catheter (USGIV) placement in emergency departments (EDs), but their interchangeability remains uncertain.  

Researchers conducted a retrospective study to compare the success rates of HHUs and CBUS for USGIV placement.  

They enrolled individuals aged 18 and older in the ED requiring USGIV placement. Participants were randomized to receive USGIVs placed using CBUS or HHU. Trained ED physicians or nurses performed the placements, with attempts defined as needle entry into the skin. Success was determined if the catheter was immediately flushable with saline. Data collected included success rates, attempt numbers, IV/provider characteristics, participant demographics, and catheter duration. Demographics and procedural details were analyzed using Pearson’s Chi-square, Fisher’s Exact test, or Wilcoxon rank-sum tests, while noninferiority was evaluated using the Farrington-Manning test. Analyses followed a per-protocol approach and were conducted using R software.  

The results showed 312 individuals were enrolled, with similar participant and IV characteristics across groups. Successful USGIV placements were comparable between CBUS and HHU, with 146 and 145 successes, respectively (P ≥0.9). First-attempt success rates were also similar (P =0.8), and HHU demonstrated noninferiority to CBUS for successful placement (P =0.0001). Premature USGIV failure rates were 4.0% for HHU and 6.7% for CBUS.  

Investigators concluded the HHUs were noninferior to CBUS for successful USGIV placement in the ED. 

Source: sciencedirect.com/science/article/pii/S0735675724005539