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
(ED) 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
were analyzed. USG PIVC insertion did not result in fewer 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% confidence interval 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
Published online: March 02, 2023
Accepted:
February 17,
2023
Received in revised form:
December 23,
2022
Received:
September 26,
2022
Publication stage
In Press Uncorrected ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
