Comparison of Ultrasound-Guided versus Landmark Method for Difficult Intravenous Cannulation in Adult Population

Peripheral intravenous  cannulation is one of the most commonly performed procedures in emergency departments. However, it can be particularly challenging in patients with difficult venous access, leading to multiple failed attempts, patient discomfort, delayed treatment, and increased complications. Traditionally, landmark-based techniques are used to identify suitable veins, but these can be unreliable in difficult access cases due to factors such as obesity, edema, chronic illness, or previous IV drug use.

This prospective, randomized controlled study aims to compare the efficacy and safety of ultrasound-guided versus conventional landmark-based methods for peripheral IV cannulation in adults with difficult venous access in the emergency department. Eligible participants with predefined criteria for difficult IV access will be randomized into two groups one undergoing ultrasound-guided cannulation and the other using the standard landmark technique.

The primary objective is to compare the success rate of cannulation on the first attempt between the two groups. Secondary objectives include comparison of time taken for successful cannulation, number of attempts required, patient-reported pain score, and incidence of complications such as infiltration or hematoma.

The findings of this study may support broader implementation of ultrasound guidance in routine emergency care to improve success rates and patient outcomes.