Written by Drew Clare from SAEM AEUS
Spoon Feed
Improve the survival of your next ultrasound guided peripheral IV by selecting the longer catheter.
Why does this matter?
Regardless of what type of ED you work in, “we can’t get access on that patient,” is one of the most common phrases heard throughout a shift in the ED (second only to “we still need urine”). While many patients successfully receive an ultrasound guided IV, these lines fail twice as often as compared to standard IVs. Longer catheters (4.78 cm) are common in most EDs; however, if only 30% or less of the length of the catheter is within the vein, it is likely to fail in under 4 hours. While there is a growing trend toward early midline placement in the ED, this requires added training and costs.
Going the extra mile 1.57cm
The authors of this prospective, non-blinded RCT sought to compare the survival rates of the currently available 20-gauge 4.78 cm catheters (standard long) versus a 20-gauge 6.35 cm catheter (ultralong). Patients were screened for medical conditions suggestive of difficult IV access or a history of difficult IV access. The IV lines in this study were placed by a variety of ED staff (attendings, residents, APPs, nurses, and technicians), and all were placed proximal to the antecubital fossa. Research staff followed the patients for the life of the catheter. The median duration of catheter survival (primary outcome) was 44 hours longer in the ultralong catheter group. If 2.75cm of the catheter was in the vein, the survival was 54 hours longer (secondary outcome). There were fewer infiltrations and cases of phlebitis in the ultralong group.
While this study could not be truly blinded based on the different lengths of the catheters being inserted, the authors did their best to account for the bias, and those assessing the catheters were not aware of the length. Although this is an industry-funded study, the intervention of obtaining longer IV catheters is simple, effective, requires no added staff training, and will likely improve the survival of your next ultrasound-guided IV.
Source
Ultralong Versus Standard Long Peripheral Intravenous Catheters: A Randomized Controlled Trial of Ultrasonographically Guided Catheter Survival. Ann Emerg Med. 2020 Aug;76(2):134-142. doi: 10.1016/j.annemergmed.2019.11.013. Epub 2020 Jan 16.
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