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

Abstract

Background: Ultrasound-guided intravenous (US-IV) peripheral 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 longevity. We investigate the survival of an ultra long (UL) US-IV compared to a standard long (SL) US-IV. Methods: We conducted a single site, 2-arm, nonblinded, randomized controlled trial of catheter survival. Adult patients presenting to the Emergency Department (ED) with difficult vascular access were recruited and randomized to receive either SL 4.78 cm 20 gauge US-IV or UL 6.35 cm 20 gauge US-IV. The primary outcome was catheter survival. Functional catheters removed with less than 24 hours dwell time were excluded per protocol analysis. Secondary outcomes included: first-stick success, time to insertion, number of attempts, thrombosis and infection. Findings: 270 patients were enrolled between October 2018 and March 2019.194 patients met study criteria, with 99 in the SL US-IV group and 95 in the UL US-IV group. Kaplan-Meier estimate of catheter median survival time was 135.88 hours (5.66 days) [95%CI 115-310] for the UL US-IVs compared to 77.67 hours (3.23 days) [95%CI 63-102] for the SL US-IVs(p = 0.008). IVs with greater than 2.75 cm of the catheter situated in the vein lumen had a median survival of 128.90 hours (5.37 days) [95%CI 102-210] compared to 75.05 hours (3.12days) [95%CI 52-116] for IVs with ≤ 2.75 cm in the vein(p=0.006). There were no cases of catheter-related bloodstream infection or thrombosis. Interpretation: This study demonstrates increased catheter survival when >2.75 cm is situated in the vessel. UL US-IV catheters facilitate establishing this cutoff length at commonly encountered vessel depths. Further, as UL catheters have similar insertion characteristics and no additional education/training is needed for insertion competency, adoption of these catheters can occur seamlessly. Trial Registration: The trial is registered on clinicaltrials.gov Identifier: NCT03655106 and is closed to recruitment. Funding Statement: B. Braun Medical, Inc. Declaration of Interests: Dr. Bahl reports grants from B Braun Medical, Inc, during the conduct of the study. All other authors declare none. Ethics Approval Statement: The study was approved by the home institution Internal Review Board.