The Impact of Peripheral Intravenous Catheter Insertion Technique and Catheter-to-Vein Ratio on Postinsertion Failure.

Authors

Scott Leroux, Department of Emergency Medicine, Reading Hospital-Tower Health, West Reading Pennsylvania
Traci Deaner, Department of Emergency Medicine, Reading Hospital, West Reading PennsylvaniaFollow
Thomas Wasser
Craig Huey, Department of Emergency Medicine, Reading Hospital, West Reading PennsylvaniaFollow
Benjamin Carr, Department of Emergency Medicine, Reading Hospital, West Reading PennsylvaniaFollow
Alan Howard, Department of Emergency Medicine, Reading Hospital, West Reading PennsylvaniaFollow
Chrystal Anspach, Department of Emergency Medicine, Reading Hospital, West Reading PennsylvaniaFollow
Jessica Conner, Department of Emergency Medicine, Reading Hospital, West Reading Pennsylvania
Adam Sigal, Department of Emergency Medicine, Reading Hospital, West Reading PennsylvaniaFollow

Document Type

Article

Publication Date

5-2023

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. 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.

Publication Title

The Journal of emergency medicine

Volume

64

Issue

5

First Page

564

Last Page

573

Recommended Citation

Leroux, S., Deaner, T., Wasser, T., Huey, C., Carr, B., Howard, A., Anspach, C., Conner, J., & Sigal, A. (2023). The Impact of Peripheral Intravenous Catheter Insertion Technique and Catheter-to-Vein Ratio on Postinsertion Failure.. The Journal of emergency medicine, 64 (5), 564-573. https://doi.org/https://doi.org/10.1016/j.jemermed.2023.02.011