346 Ultra Long Versus Standard Long Peripheral Intravenous Catheters: A Randomized Controlled Trial of Ultrasound-Guided Catheter Survival

Abstract

Ultrasound-guided intravenous (IV) catheters have dismal dwell time with most IVs failing prior to completion of therapy. Catheter length in vein is a variable directly related to catheter survival. We investigate the survival of an ultra long peripheral IV compared to standard long peripheral IV placed under ultrasound (US)-guidance. We conducted a single site, 2-arm, nonblinded, randomized controlled trial of catheter survival. Adult patients presenting to the emergency department (ED) with a history of difficult vascular access were recruited to participate. Patients were randomized to receive either a standard long 4.78 cm length 20 gauge US-guided IV catheter or the intervention ultra long 6.35 cm length 20 gauge US-guided IV catheter. The primary outcome was catheter survival. All functional catheters removed with less than 24 hours dwell time were excluded from the survival analysis. Any catheter failure regardless of dwell time was included in the survival analysis. Secondary outcomes included evaluation of insertion parameters including first-stick success and time to insertion as well as complications including thrombosis and infection. 270 patients were enrolled. 194 patients were included in the survival analysis with 99 in the standard long IV group and 95 in the ultra long IV group. Kaplan-Meier estimate of catheter median survival time was 135.88 hours (5.66 days) [95% CI 115-310] for the ultra long IV catheters compared to 77.67 hours (3.23 days) [95% CI 63-102] for the standard long IV catheters (Log-rank Test: p = 0.008). IVs with greater than 3.1 cm of the catheter residing in vein had a median survival of 128.90 hours (5.37 days) [95% CI 96-504] compared to 76.55 hours (3.18 days) [95% CI 63-115] for IVs with less than 3.1 cm in the vein (p=0.04). This study supports the use of ultra long IV catheters over the standard length options for upper arm insertions as these catheters have a favorable survival profile for difficult access ED patients. The improved survival is related to the amount of catheter residing in the vein with greater than 3.1 cm catheter in vein yielding the best longevity. Further, as ultra long catheters have similar insertion characteristics and no additional education/training is needed for insertion competency, adoption of these catheters can occur seamlessly at any ED.