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Ultrasonography-Guided Long Peripheral Catheters: Real-World Outcomes in Hospitalized Children
Roberto Privato1,2, Sandra Trapani1,2, Paolo Rufini3
1Meyer Children's Hospital IRCCS, Pediatric Unit, Florence, Italy.
Insights
Ultrasonography-guided long peripheral catheters (LPCs) offer longer dwell times and higher success rates in children compared to short peripheral catheters (SPCs). This study suggests LPCs may be a preferred first-line option for pediatric vascular access.
Area of Science:
- Pediatric vascular access
- Medical device efficacy
- Ultrasound-guided procedures
Background:
- Short peripheral catheters (SPCs) are common but often lead to insertion difficulties and short dwell times in children.
- Limited evidence exists for ultrasonography-guided long peripheral catheters (LPCs) in pediatric wards, especially for 3-6.5 cm lengths.
Purpose of the Study:
- To compare the efficacy and safety of ultrasonography-guided LPCs versus blind-inserted SPCs in pediatric patients.
- To evaluate catheter survival, therapy completion, and complication rates between the two catheter types.
Main Methods:
- Retrospective observational study including pediatric patients (30 days to 18 years) hospitalized for at least 5 days.
- Outcomes assessed: catheter survival time, therapy completion with the first catheter, and complications per 1000 catheter-days.
- Statistical analyses included Kaplan-Meier curves, Cox regression, Poisson regression, and propensity score matching.
Main Results:
- LPCs demonstrated significantly longer median catheter survival (7.0 days vs. 3.0 days) and higher therapy completion rates (56.1% vs. 17.2%) compared to SPCs.
- Complication rates were substantially lower with LPCs (65.5 vs. 193.6 per 1000 catheter-days).
- Adjusted analyses indicated LPCs had a lower risk of failure and were protective against early removal.
Conclusions:
- Ultrasonography-guided LPCs provide superior dwell time, successful therapy completion, and reduced complications in pediatric patients compared to blind-inserted SPCs.
- LPCs should be considered a primary vascular access choice for children needing medium-term therapy, especially those with difficult access or on antibiotics.
Objective:
Despite being the most common vascular access devices in pediatric settings, short peripheral catheters (SPCs) frequently result in difficult insertion, limited dwell time, and multiple replacements. Ultrasonography-guided long peripheral catheters (LPCs) may improve catheter longevity, but evidence in pediatric wards remains limited, particularly for LPCs measuring 3 to 6.5 cm. We compared ultrasonography-guided LPCs with blind-inserted SPCs in this setting.
Patients And Methods:
We conducted a retrospective observational study. Patients aged 30 days to 18 years that were hospitalized for at least 5 days were included. Outcomes included catheter survival time, therapy completion with the first catheter, and complications per 1000 catheter-days. Statistical analyses included Kaplan-Meier survival curves, adjusted Cox regression, Poisson regression, and propensity score matching.
Results:
Among 250 patients, 41 received LPCs and 209 received SPCs. Median catheter survival was longer for LPCs (7.0 days; 95% CI, 5.0-9.0) than SPCs (3.0 days; 95% CI, 2.5-3.5; P < .0001). LPCs had lower risk of failure in adjusted Cox regression (hazard ratio, 0.51; 95% CI, 0.32-0.81; P = .004). Therapy completion with the first catheter occurred in 56.1% of patients with LPCs vs 17.2% of patients with SPCs (P < .0001). Complication rates were lower with LPCs (65.5 vs 193.6 per 1000 catheter-days; incidence rate ratio, 3.10; 95% CI, 1.98-4.85; P < .001). In multivariable analysis, LPCs were protective against early removal, whereas antibiotics and longer treatment duration increased failure risk.
Conclusions:
Ultrasonography-guided LPCs showed longer dwell time, higher therapy completion rates, and fewer complications compared with blind-inserted SPCs. These findings support considering LPCs as first-line vascular access option in children requiring medium-term therapy, particularly those with difficult access or receiving antibiotics.
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