Ultrasound-guided peripheral IV placement practices: A national survey of gel and probe cover use

Point-of-care ultrasound is often used to obtain peripheral intravenous (PIV) access in the emergency department, but the coupling gel can be a source of healthcare-associated infections. On May 13, 2025, the Department of Public Health (DPH) and the Centers for Disease Control and Prevention (CDC) issued a national warning regarding growth of Paraburkholderia fungorum in non-sterile ultrasound gel products, which was in line with both regulatory agencies and specialty society recommendations. The aim of this study was to evaluate the change in ultrasound gel and policies that occurred after the CDC recommendation, along with an evaluation of ultrasound gel and cover use for ultrasound-guided PIV (US-PIV) access.

This study was a cross-sectional, national survey of US-PIV use in emergency departments (ED) taking place between August 14, 2025, and September 31, 2025. A 15-question Qualtrics survey was sent out to emergency medicine ultrasound organizations. Inclusion criteria was response to the survey, including any international responses, with responses excluded if duplicates were detected. The primary study outcome was the percentage of EDs making changes to their US-PIV gel or policies in response to the CDC recommendation to switch to using sterile gel for all percutaneous procedures. Secondary outcomes included type of gel and level of sterility being used for US-PIV, probe covers used for US-PIV, who performs US-PIV, and whether institutions use sterile gel for non-procedural POCUS examinations. Descriptive statistics were performed using Microsoft Excel.

A total of 175 unique responses were received, with 143 included after assessment for duplicate institutional responses. An ED policy for US-PIV was reported at 107 institutions (74.8%), whereas 29 (20.2%) reported no policy, and 7 (4.9%) respondents did not know whether such a policy existed. No changes were made at 98 (68.5%) of the responding institutions, however, 72 (73.5%) of these institutions already used sterile gel for US-PIV. Of the 34 (23.8%) institutions who reported making changes, 31 changed gel to a sterile product for US-PIV, and 3 changed their ED US-PIV policy. For US-PIV gel use, 134 (93.7%) institutions reported using single-use ultrasound gel packets, of which 29 (21.6%) reported using non-sterile single-use ultrasound gel packets or surgilube and 105 (78.4%) reported sterile gel packet use. This is compared to 9 (6.3%) institutions using gel from a multiuse bottle. Noted themes based on respondent comments included both a shift towards sterile gel after the CDC recommendations and inconsistent adherence on both gel and probe cover.

Our survey found that approximately 25% of responding institutions made changes to their US-PIV policy or gel selection in response to the CDC recommendation to use sterile gel for percutaneous procedures. Close to half of all institutions were already compliant with the sterile gel recommendations and did not need to modify their practices. However, many institutions still do not use covers or sterile gel for US-PIVs, suggesting a need for better compliance with current recommendations.