Decrease in central venous catheter placement due to use of ultrasound guidance for peripheral intravenous catheters

Area of Science:

• Emergency Medicine
• Vascular Access
• Medical Ultrasound

Background:

• Obtaining intravenous (IV) access in the emergency department (ED) is often challenging.
• Physicians frequently resort to central venous catheters (CVCs) for difficult IV access.
• The impact of ultrasound-guided peripheral IV catheters (USGPIVs) on CVC reduction is not well-quantified.

Purpose of the Study:

• To quantify the reduction in CVC placement achieved by USGPIV.
• To assess the efficacy and complication rates of USGPIVs in patients with difficult IV access.

Main Methods:

• Prospective, observational study in two urban EDs.
• Enrolled patients requiring CVC due to failed IV access attempts.
• Ultrasound-trained physicians performed USGPIV placement, with 7-day follow-up for CVC placement and complications.

Main Results:

• USGPIV was initially successful in all 100 patients.
• 12% of USGPIVs failed before ED disposition, leading to 4 CVCs and 7 repeat USGPIVs.
• Overall, 15% of patients ultimately received a CVC, with a 6.7% complication rate among those receiving a CVC.

Conclusions:

• Ultrasound-guided peripheral IV catheters prevented CVC placement in 85% of patients with difficult IV access.
• USGPIVs have the potential to significantly reduce CVC use and associated morbidity in this population.