Abstract
Background
Peripheral intravenous catheter (PIVC) postinsertion failure rates are unacceptable.
Ultrasonography is an adjunctive tool that may improve PIVC utilization success.
Objectives
Determine if ultrasonographically guided (USG) PIVCs placed in the emergency department
significantly decreases postinsertion failure rate, increases utility time, and decreases
postremoval complication rate. Determine if catheter-to-vein ratio (CVR) predicts
postinsertion failure.
Methods
Participants were randomized to either standard or USG cohort. Data collection included
participant and PIVC characteristics, vein measurements, postinsertion failure, and
postremoval complication. Chi-square analysis compared postinsertion failure rates.
Group t-test compared utility times. Postremoval complication rates were compared
with standard rate analysis by Fleiss. The receiver operating characteristic curve
was calculated to determine if CVR could predict postinsertion failure. An enrollment
of 582 was estimated.
Results
A total of 223 patients were enrolled with 222 PIVCs investigated. Standard cohort
included 116 PIVCs and USG cohort included 106 PIVCs. A total of 212 vein diameters
analyzed. USG PIVC insertion did not result in less postinsertion failures (p = 0.654)
or longer utility time (p = 0.808). Postremoval complications were not significantly
lower (p = 0.414). Receiver operating characteristic curve showed a cut off CVR of
∼ 0.21. Area under the curve was 0.621 (p = 0.063, 95% CI 0.508-0.734).
Conclusion
The USG technique did not decrease postinsertion failure rate, increase utility time,
or significantly decrease postremoval complication rate. A CVR predictive of postinsertion
failure could not be determined.
Keywords
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Article info
Publication history
Accepted:
February 17,
2023
Received in revised form:
December 23,
2022
Received:
September 26,
2022
Publication stage
In Press Accepted ManuscriptFootnotes
Declarations of interest: none
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
