Ultralong Versus Standard Long Peripheral Intravenous Catheters: A Randomized Controlled Trial of Ultrasonographically Guided Catheter Survival

Abstract

Study objective: Ultrasonographically guided intravenous peripheral catheters have dismal dwell time, with most intravenous lines failing before completion of therapy. Catheter length in the vein is directly related to catheter longevity. We investigate the survival of an ultralong ultrasonographically guided intravenous peripheral catheter compared with a standard long one. Methods: We conducted a single-site, nonblinded, randomized trial of catheter survival. Adult patients presenting to the emergency department with difficult vascular access were recruited and randomized to receive either standard long, 4.78-cm, 20gauge ultrasonographically guided intravenous peripheral catheters or ultralong, 6.35-cm, 20-gauge ultrasonographically guided intravenous peripheral catheters. The primary outcome was duration of catheter survival. The secondary outcome was the optimal length of the catheter in the vein to maximize survival. Additional intravenous-related endpoints included first-stick success, time to insertion, number of attempts, thrombosis, and infection. Results: Between October 2018 and March 2019, 257 patients were randomized, with 126 in the standard long ultrasonographically guided intravenous peripheral catheter group and 131 in the ultralong group. Kaplan-Meier estimate of catheter median survival time in the ultralong group was 136 hours (95% confidence interval [CI] 116 to 311 hours) compared with 92 hours (95% CI 71 to 120 hours) in the standard long group, for a difference of 44 hours (95% CI 2 to 218 hours). The optimal catheter length in the vein was 2.75 cm, and intravenous lines with greater than 2.75 cm inserted had a median survival of 129 hours (95% CI 102 to 202 hours) compared with 75 hours (95% CI 52 to 116 hours) for intravenous lines with less than or equal to 2.75 cm, for a difference of 54 hours (95% CI 10 to 134 hours). Insertion characteristics were similar between the groups: 74.1% versus 79.4% first-stick success (95% CI for the difference-2% to 5%), 1.4 versus 1.3 for number of attempts (95% CI for the difference-0.1 to 0.3), and 6.9 versus 5.9 minutes to completion (95% CI for the difference-1.3 to 3.4) with ultralong versus standard long, respectively. There were no cases of infection or thrombosis. Conclusion: This study demonstrated increased catheter survival when the ultralong compared with the standard long ultrasonographically guided intravenous peripheral catheter was used, whereas insertion characteristics and safety appeared similar. [

Ultrasound-guided peripheral vascular catheterization in pediatric patients: a narrative review

“…Furthermore, the risk of catheter failure decreased by 29% for every 5% increase of catheter length located in vein. This evidence is supported by another study investigating the survival of an ultralong peripheral catheter in adults than a standard-length catheter in ultrasound guidance; it reported a markedly higher catheter survival rate when the catheter length in the vein exceeded 2.75 cm [29].…”

Catheter Length In-Vein Impacts Ultrasound-Guided Peripheral Intravenous Catheter Survival

“…The value of longer peripheral catheters cannot be overstated, and the increased length in-vein has been a key variable in helping transform catheter survival outcomes. [2][3][4][5] USguided venous access is no longer a form of bridge or temporary access lasting a mere 24 hours or less but now is a reliable vascular access strategy with most catheters surviving for several days to completion of therapy. The evidence now strongly supports consideration of catheter length in US PIV insertions, and the 2021 Infusion Nursing Standards was also updated to include this recommendation.…”

“…Several publications over the last few years have shown that catheter length in-vein is a significant predictor of enhanced survival in US-guided insertions. [2][3][4][5] In 2018, Pandurangadu et al 3 prospectively investigated the relationship of catheter length in-vein and US PIV survival in a 4.78-cm PIV. The authors found that when < 30% of the catheter was in the vein, 100% of the catheters failed (median time to failure of 15.6 hours) compared with no IV failures when ≥ 65% of the catheter was in the vein.…”

“…Bahl et al 5 observed that most clinicians preferentially choose a shallower approach to the vein with > 50% of placements having an angle of insertion < 30°. With a shallower approach, the added distance to the vein further substantiates the use of a longer catheter to obtain 2.75 cm into the vein.…”

Techniques and Technologies to Improve Peripheral Intravenous Catheter Outcomes in Pediatric Patients: Systematic Review and Meta‐Analysis

“…3,11 Exactly why PIVC insertion is difficult in children, and the mechanisms of failure, are unknown. It is likely to be multifaceted and related to factors concerning the patient (eg, comorbidities, age, gender, adiposity), 11,12 provider (eg, insertion practice, care, and maintenance), 3,13,14 device (eg, size, length, catheter-to-vein ratio), 15,16 and therapy (eg, vessel irritation). 11,13,17 Observational studies and randomized controlled trials (RCTs) in hospitalized pediatric patients report that the average PIVC dwell is approximately 48 hours, suggesting multiple PIVCs are required to complete a single admission.…”