Abstract
ObjectivePeripheral intravenous catheter (PIVC) failure occurs frequently, but the underlying mechanisms of failure are poorly understood. We aim to identify ultrasonographic factors that predict impending PIVC failure prior to clinical exam.MethodsWe conducted a single site prospective observational investigation at an academic tertiary care center. Adult emergency department (ED) patients who underwent traditional PIVC placement in the ED and required admission with an anticipated hospital length of stay greater than 48 hours were included. Ongoing daily PIVC assessments included clinical and ultrasonographic evaluations. The primary objective was to identify ultrasonographic PIVC site findings associated with an increased risk of PIVC failure. The secondary outcome was to determine if ultrasonographic indicators of PIVC failure occurred earlier than clinical recognition of PIVC failure.ResultsIn July and August of 2020, 62 PIVCs were enrolled. PIVC failure occurred in 24 (38.71%) participants. Multivariate logistic regression demonstrated that the presence of ultrasonographic subcutaneous edema [AOR 7.37 (1.91, 27.6) p = 0.0030] was associated with an increased likelihood of premature PIVC failure. Overall, 6 (9.67%) patients had subcutaneous edema present on clinical exam, while 35 (56.45%) had subcutaneous edema identified on ultrasound. Among patients with PIVC failure, average time to edema detectable on ultrasound was 46 hours and average time to clinical recognition of failure was 67 hours (P = < 0.0001).ConclusionsPresence of subcutaneous edema on ultrasound is a strong predictor of PIVC failure. Subclinical subcutaneous edema occurs early and often in the course of the PIVC lifecycle with a predictive impact on PIVC failure that is inadequately captured on clinical examination of the PIVC site. The early timing of this ultrasonographic finding provides the clinician with key information to better anticipate the patient’s vascular access needs. Further research investigating interventions to enhance PIVC survival once sonographic subcutaneous edema is present is needed.
Highlights
The placement of peripheral intravenous catheters (PIVC) is the most commonly performed invasive procedure in the acute care clinical setting with over 300 million PIVCs inserted annually in the United States alone [1,2,3]
Multivariate logistic regression demonstrated that the presence of ultrasonographic subcutaneous edema [Adjusted Odds Ratios (AOR) 7.37 (1.91, 27.6) p = 0.0030] was associated with an increased likelihood of premature PIVC failure
6 (9.67%) patients had subcutaneous edema present on clinical exam, while 35 (56.45%) had subcutaneous edema identified on ultrasound
Summary
The placement of peripheral intravenous catheters (PIVC) is the most commonly performed invasive procedure in the acute care clinical setting with over 300 million PIVCs inserted annually in the United States alone [1,2,3]. Venous and soft tissue changes may include: narrowing of the vein wall, vein wall thickening, subcutaneous edema, and presence of thrombus These changes can occur even in the absence of any clinical signs or symptoms evident on external exam [9]. It is possible that earlier identification of impending failure may allow for meaningful intervention to reverse course or salvage a PIVC and quantification of this time interval is a necessary first step. At a minimum, these findings may help the clinician anticipate future vascular access needs
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