Emerg Med J 30:521-526 doi:10.1136/emermed-2012-201652
  • Review

Ultrasound guidance for difficult peripheral venous access: systematic review and meta-analysis

  1. Stewart R Walsh1,2
  1. 1Vascular Research Unit, University Hospital Limerick, Limerick, Ireland
  2. 2Graduate Entry Medical School, University of Limerick, Limerick, Ireland
  1. Correspondence to Dr Mary Clarke-Moloney, Research Manager, Vascular Research Unit, University Hospital Limerick, Limerick, Ireland; mary.clarkemoloney{at}
  1. Contributors All authors listed on this paper have fulfilled the criteria of authorship.

  • Accepted 11 July 2012
  • Published Online First 11 August 2012


Background Establishing intravenous access is often vital in an acute hospital setting but can be difficult. Ultrasound-guided cannulation increases success rates in prospective studies. However, these studies have often lacked a comparative group. This systematic review and meta-analysis aimed to determine the clinical effectiveness of Ultrasound-guided peripheral intravenous cannulation compared with the standard technique in patients known to have difficult access.

Methods Electronic abstract databases, trial registries, article reference lists and internet repositories were searched using the following search terms: ‘peripheral venous cannulation’, ‘peripheral venous access’. Studies meeting the following criteria were included: randomised controlled trial patients of all ages who required peripheral intravenous access; interventions were Ultrasound-guided versus standard cannulation technique; patients were identified as having difficult venous access; inclusion of at least one defined outcome (procedural success time to cannula placement; number of attempts).

Results 7 trials were identified (289 participants). Ultrasound guidance increases the likelihood of successful cannulation (pooled OR 2.42; 95% CI 1.26 to 4.68; p=0.008). There were no differences in time to successful cannulation, or number of percutaneous skin punctures.

Conclusion Ultrasound guidance increases the likelihood of successful peripheral cannulation in difficult access patients. We recommend its use in patients who have difficult venous access, and have failed venous cannulation by standard methods. Further randomised controlled trials (RCTs) with larger sample sizes would be of benefit to investigate if Ultrasound has any additional advantages in terms of reducing the procedure time and the number of skin punctures required for successful venous cannulation.


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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