Spiced RCT: Success and Pain Associated with Intravenous Cannulation in the Emergency Department Randomized Controlled Trial.

BACKGROUND: Peripheral venous cannulation is one of the most common procedures in medicine. A larger cannula allows higher rates of fluid to be provided if needed in a deteriorating patient; however, it is also perceived that larger-gauge cannula placement is associated with increased pain and procedural difficulty. OBJECTIVE: This study aimed to compare the pain and procedural difficulty experienced during insertion between 18-gauge (18G) and 20-gauge (20G) cannulas. METHODS: We conducted a single-blinded, randomized controlled trial on adult patients who required peripheral IV cannulation within a tertiary hospital emergency department between April and October 2018. Patients were randomized to either the 18G or 20G cannula group. The primary outcomes of the study-pain experienced by patients and procedural difficulties experienced by clinical staff-were recorded on two separate 10-cm visual analog scales. Other outcomes include first-attempt success rate, operator designation, complications, and the intent and actual use of the IV cannula were documented on preformatted questionnaires. RESULTS: Data from 178 patients were included in the analysis. Eighty-nine patients were allocated to each cannula group. There were no statistically or clinically significant differences between mean pain score (0.23; 95% CI 0.56-1.02; p = 0.5662) and mean procedural difficulty score (0.12; 95% CI 0.66-0.93; p = 0.7396). between the two groups. There was no difference in first-attempt success rate (73 of 89 vs. 75 of 89; p = 0.1288), complications (2 of 89 vs. 1 of 89) between the 20G group and 18G group, respectively. CONCLUSIONS: There was no significant difference between the 18G or 20G cannula for either pain experienced by patients or procedural difficulty experienced by clinicians.

A diagnostic dilemma of an 18-week cervical ectopic pregnancy: A case report.

INTRODUCTION: Cervical ectopic pregnancy (CEP) is characterised by the implantation of trophoblastic tissue within the cervical canal and is associated with a significant risk of maternal morbidity and mortality. This case report addresses a second-trimester CEP with unusual sonographic features suspicious of placenta accreta spectrum (PAS), which was successfully managed with an abdominal hysterectomy. CASE PRESENTATION: A 27-year-old woman, G6P2, presented to the labour ward of a rural hospital at 18 weeks of gestation with premature rupture of membranes. The index pregnancy was complicated by an absence of any antenatal care, as well as a history of cigarette smoking and cannabis use. An ultrasound scan demonstrated a live pregnancy with the foetal head within the cervical canal. A termination of pregnancy was arranged with misoprostol 200 mg orally followed by an oxytocin induction. However, a repeat ultrasound scan, after 12 h of oxytocin infusion, which failed to terminate the pregnancy, demonstrated a still live foetus as well as increased vascularity, concerning for PAS. The patient underwent an emergency abdominal hysterectomy, with an intraoperative diagnosis of a CEP. The postoperative course was unremarkable, and the patient was discharged home on day 3 post-operatively. DISCUSSION: Appropriate antenatal care and early booking-in would have identified a CEP early in gestation and allowed for minimally invasive management and potential conservation of fertility. When this is not possible in such cases, meticulous pre-operative planning by a gynaecologist with experience in advanced pelvic surgery can minimise the associated morbidity and mortality.