Factors Associated With Survival of Ultrasound-Guided Peripheral Intravenous Catheters

Ultrasound-guided peripheral IV (USPIV) catheter placement is a common emergency department (ED) procedure, but it is also known to have high rates of failure.

To identify patient and procedural factors that predict USPIV survival.

An ED ultrasound quality assurance database was retrospectively reviewed to identify USPIV in adult patients from 2020 to 2022. Patient, procedural, and USPIV dwell data were extracted. The primary outcome was survival of the USPIV for 72 h or until discharge. A logistic regression with stepwise selection was performed to assess factors associated with USPIV survival outcomes.

Of 498 USPIV in our database, 66.5% survived to discharge or at least 72 h. Vessel depth (6.4 mm vs. 7.5 mm; odds ratio [OR] = 0.91; 95% confidence interval [CI] = 0.86-0.96), USIV placed by a resident (60.4% vs. 71.3%; OR = 0.63; 95% CI = 0.41-0.96), systolic blood pressure < 90 mm Hg (0.9% vs. 6.0%; OR = 0.21; 95% CI = 0.05-0.80), and history of IV drug use (11.8% vs. 19.2%; OR = 0.54; 95% CI = 0.32-0.92) were associated with worsened survival. History of end-stage renal disease (17.5% vs. 10.2%; OR = 1.90; 95% CI = 1.03-3.49) was associated with improved survival.

USPIV can be a successful vascular access for ED patients. Further research remains necessary to determine ways to predict and minimize USPIV failure. Increasing vessel depth, resident operator placement, hypotension, and a history of IV drug use were associated with decreased USPIV survival at 72 h.