Ultrasound-guided peripheral intravenous access in the emergency department: A national cost, complication, and...

Ultrasound-guided peripheral intravenous line (US-PIV) placement is highly effective for patients with difficult intravenous access (DIVA); yet its broader impact in emergency departments (EDs) in the United States has not been adequately quantified. This study aimed to evaluate the national impact of US-PIV on cost savings, complication avoidance, and throughput in the ED.

Using published data, we constructed a Monte Carlo simulation model to evaluate US-PIV for patients with DIVA in the ED. Each iteration simulated annual ED visits, the proportion of patients requiring PIV access, the prevalence of DIVA, and ultrasound success. Primary outcomes included annual cost savings, central venous catheters (CVCs) avoided and complications prevented, and ED throughput time savings (across laboratory turnaround, contrast administration, intravenous fluids, pain medications, admission, and discharge orders). Results are reported as point estimates with 95% uncertainty intervals (UI) from 1000 iterations.

In the simulation model, US-PIV resulted in an annual average estimated opportunity-cost savings of $1.06 billion (95% UI: $945 M-$1.19B), driven primarily by staff-time opportunity-cost savings ($578 M) and avoided CVCs ($457 M). The model estimated avoidance of 3.84 million CVCs annually, preventing 226,741 total complications and 115,292 major complications including pneumothorax, infection, arterial cannulation, and deep vein thrombosis. Per patient with DIVA, ultrasound saved an average of $125, avoided 0.45 CVCs, and prevented 0.027 complications. Throughput effects were directionally favorable but had wide uncertainty intervals and were not statistically significant, with average savings ranging from 29 to 89 min per patient depending on workflow step.

US-PIV for patients with DIVA has the potential to generate substantial national annual opportunity-cost savings and reduce CVC-related complications under modeled assumptions. Throughput benefits remain uncertain. These findings support integration of US-PIV into ED vascular access protocols where local operational capacity and trained personnel are available.