377 Infiltration Rates are Similar in Ultrasound-Guided and Traditionally Placed Peripheral IVs in Admitted Emergency Department Patients With Difficult IV Access

Abstract

Study ObjectivesUltrasound-guided peripheral intravenous (USGPIV) catheter placement is a useful tool in obtaining intravenous (IV) access in patients, especially in patients who fail traditional techniques. Previous studies suggest the USGPIV technique may be associated with a higher rate of failure and infiltration than the traditional landmark and palpation-based approach. The purpose of this study was to determine and compare the infiltration rate of two methods of peripheral IV catheter placement in patients who had difficult IV access during their emergency department (ED) stay and were subsequently admitted to the hospital.MethodsA retrospective analysis of all patients who had documented placement of an USGPIV in an academic tertiary emergency department with an associated emergency medicine residency program from November 2008 to June 2014 was conducted. Patients who failed initial traditional approach and required USGPIV placement defined our population of difficult IV access patients. Only those requiring admission were included for analysis. Inpatient nursing documentation was reviewed for each admitted patient to determine the presence or absence of infiltration for each catheter (ultrasound guided and traditional approach) during their inpatient stay. A peripherally placed IV catheter was excluded if nursing documentation was absent or incomplete for that particular IV. A repeated-measures logistic regression model was developed to test for an effect that either placement technique had on the likelihood of developing an infiltration.ResultsDuring the study period, 1112 patients had documented USGPIV placement in the ED and were admitted to the hospital. Inpatient nursing records were present for 885 USGPIVs that resulted in 67 infiltration events during hospital admission, a prevalence of 7.6%. Similarly, 1803 documented traditionally placed IVs resulted in 107 infiltration events, a prevalence of 5.9%. The placement technique was not clearly documented for 12 infiltration events, which were excluded from analysis. Repeated measures logistic regression found no significant association between technique and likelihood of infiltration (OR for technique =1.31 [CI: 0.92, 1.88]; P = .137).ConclusionsIn ED patients who present with difficult IV access and are admitted to the hospital, infiltration rates of peripheral IV catheters are low. There was no significant difference in infiltration rates between those placed using ultrasound and those placed with a traditional approach. Study ObjectivesUltrasound-guided peripheral intravenous (USGPIV) catheter placement is a useful tool in obtaining intravenous (IV) access in patients, especially in patients who fail traditional techniques. Previous studies suggest the USGPIV technique may be associated with a higher rate of failure and infiltration than the traditional landmark and palpation-based approach. The purpose of this study was to determine and compare the infiltration rate of two methods of peripheral IV catheter placement in patients who had difficult IV access during their emergency department (ED) stay and were subsequently admitted to the hospital. Ultrasound-guided peripheral intravenous (USGPIV) catheter placement is a useful tool in obtaining intravenous (IV) access in patients, especially in patients who fail traditional techniques. Previous studies suggest the USGPIV technique may be associated with a higher rate of failure and infiltration than the traditional landmark and palpation-based approach. The purpose of this study was to determine and compare the infiltration rate of two methods of peripheral IV catheter placement in patients who had difficult IV access during their emergency department (ED) stay and were subsequently admitted to the hospital. MethodsA retrospective analysis of all patients who had documented placement of an USGPIV in an academic tertiary emergency department with an associated emergency medicine residency program from November 2008 to June 2014 was conducted. Patients who failed initial traditional approach and required USGPIV placement defined our population of difficult IV access patients. Only those requiring admission were included for analysis. Inpatient nursing documentation was reviewed for each admitted patient to determine the presence or absence of infiltration for each catheter (ultrasound guided and traditional approach) during their inpatient stay. A peripherally placed IV catheter was excluded if nursing documentation was absent or incomplete for that particular IV. A repeated-measures logistic regression model was developed to test for an effect that either placement technique had on the likelihood of developing an infiltration. A retrospective analysis of all patients who had documented placement of an USGPIV in an academic tertiary emergency department with an associated emergency medicine residency program from November 2008 to June 2014 was conducted. Patients who failed initial traditional approach and required USGPIV placement defined our population of difficult IV access patients. Only those requiring admission were included for analysis. Inpatient nursing documentation was reviewed for each admitted patient to determine the presence or absence of infiltration for each catheter (ultrasound guided and traditional approach) during their inpatient stay. A peripherally placed IV catheter was excluded if nursing documentation was absent or incomplete for that particular IV. A repeated-measures logistic regression model was developed to test for an effect that either placement technique had on the likelihood of developing an infiltration. ResultsDuring the study period, 1112 patients had documented USGPIV placement in the ED and were admitted to the hospital. Inpatient nursing records were present for 885 USGPIVs that resulted in 67 infiltration events during hospital admission, a prevalence of 7.6%. Similarly, 1803 documented traditionally placed IVs resulted in 107 infiltration events, a prevalence of 5.9%. The placement technique was not clearly documented for 12 infiltration events, which were excluded from analysis. Repeated measures logistic regression found no significant association between technique and likelihood of infiltration (OR for technique =1.31 [CI: 0.92, 1.88]; P = .137). During the study period, 1112 patients had documented USGPIV placement in the ED and were admitted to the hospital. Inpatient nursing records were present for 885 USGPIVs that resulted in 67 infiltration events during hospital admission, a prevalence of 7.6%. Similarly, 1803 documented traditionally placed IVs resulted in 107 infiltration events, a prevalence of 5.9%. The placement technique was not clearly documented for 12 infiltration events, which were excluded from analysis. Repeated measures logistic regression found no significant association between technique and likelihood of infiltration (OR for technique =1.31 [CI: 0.92, 1.88]; P = .137). ConclusionsIn ED patients who present with difficult IV access and are admitted to the hospital, infiltration rates of peripheral IV catheters are low. There was no significant difference in infiltration rates between those placed using ultrasound and those placed with a traditional approach. In ED patients who present with difficult IV access and are admitted to the hospital, infiltration rates of peripheral IV catheters are low. There was no significant difference in infiltration rates between those placed using ultrasound and those placed with a traditional approach.