190 Long-Term Survival of Ultrasound Guided Peripheral Intravenous Catheters

Abstract

In patients with difficult vascular access, ultrasound-guided peripheral IVs (USGPIVs) have emerged as a safe and viable option. After placement in the emergency department (ED), current CDC guidelines recommend removal or replacement of the USGPIV no more frequently than every 72 to 96 hours. However, the effective longevity of USGPIVs in adults is poorly defined; on review, only two studies have indirectly assessed survival of the most common USGPIV catheters after the 96-hour mark. Therefore, the primary objective of our study was to define, in admitted patients, the long-term survival of USGPIVs that were placed in the ED. Secondary objectives included defining the risk factors for early removal of USGPIVs and the reasons for USGPIV failure. We performed a prospective cohort study in admitted patients, in which we followed 124 USGPIV catheters placed in the adult ED for 7 days or until removal, whichever came first. After enrollment, study personnel used ultrasound to measure vein depth and width. Catheter gauge and the chosen vein were recorded. We performed chart review to assess patient factors including BMI, diabetes, intravenous drug use, sickle cell disease, thrombophilia, and cancer. If the catheter was removed early, the reason for unplanned removal was documented. Of the 124 USGPIV catheters followed, 84 (68%) lasted until discharge or until the catheter was no longer needed (planned removal), while 40 (32%) were removed early due to complications (early removal). However, surviving 84 hours after placement significantly reduced the risk of early removal (relative risk, 0.760; p < 0.05); only 22% of USGPIV catheters that survived 84 hours subsequently required early removal. In contrast, a BMI > 40 increased the risk for early removal (relative risk, 2.23; p < 0.05). No other factors we assessed were significantly associated with early USGPIV removal. Complications resulting in early USGPIV removal included infiltration (35%), loss of catheter function (32.5%), pain (17.5%), dislodgement (12.5%), and excessive bruising (2.5%). In our study of admitted patients with an USGPIV placed in the ED, approximately 1/3 needed to be removed earlier than anticipated. A BMI >40 was the only risk factor we found to be significantly associated with need for early removal. Infiltration or loss of catheter function were the two most common reasons for early removal.