INTRAVENOUS ACCESS IN THE CRITICALLY ILL TRAUMA PATIENT - A MULTICENTERED, PROSPECTIVE, RANDOMIZED TRIAL OF SAPHENOUS CUTDOWN AND PERCUTANEOUS FEMORAL ACCESS

Study objective: To compare the speed of IV access and the rate of inf usion for saphenous venous cutdown and percutaneous femoral catheteriz ation. Design: Prospective, randomized, multicentered trial. Patient e nrollment occurred from September 1990 through September 1991. Setting : Patients were enrolled at three urban Level I trauma centers. Type o f participants: Seventy-eight critically ill trauma patients. Interven tions: Participants were randomized to one of two groups: saphenous cu tdown or percutaneous femoral line. After successful cannulation of th e vein, 1 L of crystalloid was infused by gravity. Results: The mean p rocedure time for the cutdown group was 5.63 +/- 2.58 minutes compared with 3.18 +/- 1.19 minutes for the femoral line group (P > .0001). Th e mean infusion time for the cutdown group was 6.65 +/- 4.29 minutes c ompared with 4.56 +/- 2.47 minutes for the femoral line group (P < .03 ). The mean overall time for the cutdown group was 11.76 +/- 4.81 minu tes compared with 7.67 +/- 2.78 minutes for the femoral line group (P < .0002). Conclusion: Percutaneous femoral catheterization can be perf ormed more rapidly than saphenous cutdown in the critically ill trauma patient with a palpable femoral pulse and allows for more rapid fluid administration. We support the.use of a percutaneous femoral line as an acceptable alternative to saphenous venous cutdown in the initial r esuscitation of trauma patients.