Mismatch Between Antecubital Peripheral Intravenous Catheter Insertion and Contrast CT Use in the Emergency...

Antecubital fossa (ACF) placement of peripheral intravenous catheters (PIVCs) is generally not recommended due to higher infection and device failure risk. However, ACF placement is common and justified in emergency departments (EDs) if injection of contrast for computed tomography (CT) is anticipated. However, it is unknown how successful ED staff are at correctly predicting contrast-enhanced CT need.

To determine the prevalence of ACF PIVC insertions in EDs, their association with contrast-enhanced CT use, and key patient and clinical predictors of contrast administration.

This retrospective cohort study was conducted in a metropolitan ED in Australia. Out of 1196 patients, 447 patients were eligible and included in the data analysis. The primary outcome was the proportion of ACF PIVCs linked to subsequent contrast-enhanced CT. Secondary analyses explored demographic and clinical predictors of contrast-enhanced imaging.

Overall, 80% of PIVCs were inserted in the ACF. However, only 27% of patients subsequently underwent contrast-enhanced CT, indicating that approximately 73% of ACF insertions were potentially avoidable. Multivariate analysis revealed that female patients (OR = 0.599, p = 0.044), and gastrointestinal (OR = 3.397, p = 0.002) or neurological conditions (OR = 5.101, p < 0.001) had significantly higher odds of receiving contrast-enhanced CT.

This study identifies a clear discrepancy between clinical guidelines and actual practice. Many ACF insertions appear to be based on incorrect assumptions rather than confirmed clinical need. The findings highlight the need for more targeted, evidence-based decision-making in EDs.