Open Access Emergency Medicine (May 2023)

Outcomes of Ultrasound Guided Peripheral Intravenous Catheters Placed in the Emergency Department and Factors Associated with Survival

  • Malik A,
  • Dewald O,
  • Gallien J,
  • Favot M,
  • Kasten A,
  • Reed B,
  • Wells R,
  • Ehrman RR

Journal volume & issue
Vol. Volume 15
pp. 177 – 187

Abstract

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Adrienne Malik,1 Olga Dewald,2 John Gallien,3 Mark Favot,3 Adam Kasten,5 Brian Reed,6 Robert Wells,5 Robert R Ehrman4 1Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, MO, 66160, USA; 2Department of Emergency Medicine, Sparrow Hospital, Lansing, MI, 48912, USA; 3Department of Emergency Medicine, DMC Detroit Receiving Hospital, Detroit, MI, 48201, USA; 4Department of Emergency Medicine, DMC Sinai Grace Hospital, Detroit, MI, 48235, USA; 5Department of Emergency Medicine, DMC Harper Hospital, Detroit, MI, 48201, USA; 6Department of Emergency Medicine, Wayne State University, Detroit, MI, 48201, USACorrespondence: Adrienne Malik, Department of Emergency Medicine, University of Kansas Medical Center, 4000 Cambridge St, Kansas City, MO, 66160, USA, Email [email protected]; [email protected]: Patients with difficult peripheral intravenous (IV) access are common in emergency departments (EDs). Ultrasound-guided peripheral intravenous catheters (USIVs) are frequently used in this population; however, information regarding the effect of patient and IV characteristics on the dwell time (DT) and survival probability (SP) of USIVs is limited.Objective: Our study aimed to evaluate for associations between patient or IV characteristics and the DT and SP of USIVs.Methods: Retrospective analysis was performed on a database from an ED nurse (RN) USIV training program at an urban, academic hospital. Patients over 18 years with an USIV placed during the study period were included. Subject demographics, history, IV characteristics, insertion, and removal times were collected. Data were analyzed using descriptive statistics and univariable and multivariable Cox regression. USIV survival times for variates of interest were estimated using Kaplan–Meier curves for three censoring points.Results: The final analysis cohort was 388 patients. Mean age was 56.6 years, 66.5% were female, mean BMI was 29.9 kg/m2, and 42.5% were obese (BMI ≥ 30). Median DT was 40.3 hours in admitted patients (N=340). SP for USIVs at 96 hours was 87.8%. A total of 21 of 340 (6.2%) USIVs failed. USIV location conferred a difference on DT in obese patients when dichotomized into upper arm versus antecubital fossa and forearm together (38.6 hours vs 44.6 hours, p=0.03). No factors were associated with a difference in USIV SP.Conclusion: Median USIV DT of 40.3 hours for admitted patients was higher than in previous studies. Only 7% of USIVs in our study failed. Overall, catheters survived longer than expected.Keywords: ultrasound, peripheral IV, retrospective, emergency medicine, vascular access

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