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Three Part Question

In [patients undergoing ultrasound guided peripheral venous cannulation] does [the use of a tegaderm film dressing and sterile jelly or uncovered probe and non sterile jelly] result in [higher rates of local or systemic infection]?

Clinical Scenario

You are asked by a junior colleague to help place a difficult peripheral cannula in a patient in ED using ultrasound guidance. You wonder if there is an increased risk infection from the ultrasound equipment.

Search Strategy

Medline 1966 – 04/20 using PUBMED interface.
Filtered for English language and Humans.

((((((((((((ultrasound guided iv access) OR ultrasound guided intravenous access) OR ultrasound peripheral access) OR ultrasound peripheral cannulation) OR ultrasound vascular access) OR ultrasound vascular cannulation) OR ultrasound guided iv cannulation) OR ultrasound) OR peripheral iv) OR interventional ultrasound[MeSH Terms])) AND ((((((tegaderm dressing) OR tegaderm dressing) OR ultrasound jelly) OR ultrasound gel) OR ultrasound gel sterile) OR ultrasound jelly sterile)) AND ((((infection) OR infection nosocomial) OR contamination) OR infection control[MeSH Terms])

Search Outcome

207 studies were found of which 0 were relevant.

Comment(s)

There is a paucity of literature in this area. There are several case series from non-UK hospitals of outbreaks of Burkholderia Spp./Mycobacterium Spp/MRSA in which contaminated ultrasound gel was thought to be a contributing factor. Ultrasound probe decontamination and clinician hand hygiene are both cited as other contributing factors, somewhat limiting their relevance to UK practice. These case series do not relate directly to peripheral IV access (the majority were ICU patients with central venous access).

Clinical Bottom Line

There is no evidence to support any given practice with regard to sterility when gaining peripheral IV access using ultrasound guidance. Further work is needed in this area, in the meantime it is recommended to follow local departmental/infection control guidelines.