Objective Ultrasound (US)-guided peripheral IVs have a high failure rate. We explore the relationship between the quantity of catheter residing within the vein and the functionality of the catheter over time.
Methods This was a prospective, observational single-site study. Adult ED patients with US-guided IVs had the catheter visualised under ultrasound post-placement. IV placement time and catheter length residing in the vein was obtained. Exclusions included catheter not visualised, patient discharged from ED unless IV failed, <24 hour hospitalisation unless IV failed or patient self-removed IV.
Inpatient follow-up occurred within 24, 48 and 72 hours from the IV placement time. Catheter functionality was noted. If the catheter failed, the time and reason for failure was documented.
Results 113 patients were enrolled; 27 were excluded. Of the 86 study subjects, 29 (33.7%) patients’ IVs failed and 57 (66.3%) remained functional. Median time to IV failure was 15.6 hours. 100% of IVs failed when <30% of the catheter was in the vein; 32.4% of IVs failed when 30%–64% of the catheter was in the vein; no IVs failed when ≥65% of the catheter was in the vein (p<0.0002). The HR was 0.71 (95% CI 0.60 to 0.83), and for every 5% increase of catheter in vein, the hazard of the IV failing decreases by 29% (p<0.0001).
Conclusion The quantity of catheter residing in the vein is a key predictor of long-term functionality of US-guided IVs and is strongly associated with the hazard of failure within 72 hours. Catheter failure is high when <30% of the catheter resided in the vein. Optimum catheter survival occurs when ≥65% of the catheter is placed in the vein.
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Contributors AVP and AB designed the trial. AVP, JT, ARB and AB supervised the conduct of the trial and data collection. AVP, JT, ARB and AB undertook recruitment of patients. AVP, JT and AB managed the data, including quality control. AVP and AB provided statistical advice on study design and analysed the data with assistance from the Research Institute. AVP, JT and AB drafted the manuscript, and all authors contributed substantially to its revision. AB takes responsibility for the paper as a whole.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Obtained.
Ethics approval IRB at Beaumont Health System in Royal Oak, Michigan, USA.
Provenance and peer review Not commissioned; externally peer reviewed.
Presented at AVP, JT, ARB, B Hang, AB. Does the longevity of an intravenous catheter placed under ultrasound guidance correlate with the quantity of catheter that resides within the vein? American College of Emergency Physicians October 2016 National Meeting (Las Vegas, NV).
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