Ultrasound-guided IVs: longer catheters last longer

  • Bahl A & al.
  • Ann Emerg Med
  • 16 Jan 2020

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • In emergency department (ED) patients with difficult intravenous (IV) access, ultralong peripheral catheters placed with ultrasonographic guidance last far longer than standard-length long catheters.

Why this matters

  • Up to one-third of inpatients requiring IVs have difficult access.
  • Ultrasonographically guided intravenous peripheral catheters in difficult-access patients typically fail quickly.
  • Midline and extended-dwell catheters last longer but are pricier and require special training.

Key results

  • Ultralong vs long catheter lengths:
    • Median catheter survival: 136 (95% CI, 116-311) hours vs 92 (95% CI, 71-120) hours;
      • Difference: 44 (95% CI, 9-218) hours. 
    • Risk of failure: adjusted HR, 0.44 (95% CI, 0.28-0.70).
    • Similar results in per-protocol analysis.
  • Optimal length in vein to maximize survival: ≥2.75 cm.
  • No infections or thromboses.

Study design

  • Nonblinded randomized trial (n=257).
  • Among adult ED patients with difficult intravascular access undergoing ultrasonographically guided peripheral IV catheter placement, authors randomly assigned them to standard long 4.78-cm vs ultralong 6.35-cm catheters. 
  • Placement was ≥2 cm proximal to antecubital fossa.
  • Outcome: duration of catheter survival.
  • Funding: Commercial grants to first author.

Limitations

  • Single-center study.
  • Nonblinded.
  • Many hospitals carry only catheter lengths ≤4.78 cm.