Purpose: In clinical settings, ultrasonography (US) has recently been used to aid in the insertion of peripheral intravenous catheters (PIVCs). This cross-sectional study aimed to verify the reliability and validity of a tablet-type device in assessing vein size and depth for catheter site selection and detecting thrombus with resultant subcutaneous edema as a cause of catheter failure using US. Methods: Adult patients receiving infusions via a PIVC at a university hospital between January and February 2017 were included. All participants underwent US at the PIVC site. An expert sonographer and a nurse blinded to all information, except for ultrasonograms, evaluated the data. Intraclass correlation with 95% confidence interval (CI) was used to evaluate interrater and intrarater reliability of US assessment. To assess criterion-related validity, a high-end US notebook device was used for reference data collection. Pearson's correlation coefficient was used to evaluate criterion-related validity. Results: We observed 21 patients with 26 catheters. Intraclass correlations (95% CI) for the measured vein diameters and depths were as follows: intrarater reliability, 0.92 (0.57–0.98) and 0.78 (0.10–0.95); interrater reliability, 0.95 (0.78–0.99) and 0.94 (0.77–0.99); and Pearson's correlation coefficient for criterion-related validity, 0.74 (P = 0.02) and 0.77 (P = 0.02), respectively. However, the analysis of causes of catheter failure did not show reliable validity. Conclusion: This pilot study suggests that the tablet-type device is useful for assessing peripheral veins in clinical settings.

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The frequency of phlebitis was lower in the polyurethane, in which the catheter was placed at lower angle, almost parallel to the vessel. Our results will aid in developing new catheters and in improving PIVC-securement techniques.

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Small veins are a risk factor for infiltration. However, there are no data regarding the ideal vein diameter for preventing infiltration. Using ultrasound, vessel diameter and calculated ratios of the vessel diameter to the catheter gauge were measured. The relationship between the ratio and infiltration was assessed to establish a cutoff point. The mean ratio of the infiltration group was significantly smaller than that of the no-infiltration group (P < .01), and the ratio was an independent risk factor according to the multivariable analysis. The ratio of 3.3 was determined to be the cutoff point that enables health care professionals to identify veins appropriately.

Early detection of extravasation is important, but conventional methods of detection lack objectivity and reliability. This study evaluated the predictive validity of thermography for identifying extravasation during intravenous antineoplastic therapy. Of 257 patients who received chemotherapy through peripheral veins, extravasation was identified in 26. Thermography was performed every 15 to 30 minutes during the infusions. Sensitivity, specificity, positive predictive value, and negative predictive value using thermography were 84.6%, 94.8%, 64.7%, and 98.2%, respectively. This study showed that thermography offers an accurate prediction of extravasation.

The risk of peripheral intravenous catheter failure varies according to the insertion site. This study examined catheter shape just after removal to evaluate the causes of catheter failure according to site. This study was a secondary analysis of previous study data. Our observational study was conducted during a 6-month period at The University of Tokyo Hospital. Participants were hospitalized adults who received infusion therapy via a short peripheral catheter. We acquired ultrasound images of blood vessels and surrounding tissues at the catheter insertion site before catheter removal and clinical images of the removed catheters. We analyzed 184 catheters from 142 participants. There were no significant differences in the catheter failure rate (29.9%) among insertion sites. Curvature in the middle of the catheter was present in 9.2% of cases; the median bend angle at the catheter base was 9.1° (range: 0.0°-68.3°). The bend angle of catheters inserted in the upper arm was significantly greater than of catheters in the forearm (p = 0.013). Catheter curvature was related to catheter failure (14.8% of failed catheters had curvature; p = 0.035) and occlusion (35.3% of occluded catheters had curvature; p = 0.008) in upper arm and forearm placements. The median distance from the elbow to the insertion site was shorter for failed catheters than for surviving catheters. To prevent catheter failure, especially occlusion resulting from catheter curvature, a catheter should be inserted at an appropriate insertion site far from the antecubital fossa.

Short peripheral catheter (SPC) failure is an important clinical problem. The purpose of this study was to clarify the relationship between SPC failure and etiologies such as thrombus, subcutaneous edema, and catheter dislodgment using ultrasonography and to explore the risk factors associated with the etiologies. Two hundred catheters that were in use for infusion, excluding chemotherapy, were observed. Risk factors were examined by logistic regression analysis. Sixty catheters were removed as the result of SPC failure. Frequency of thrombus with subcutaneous edema in SPC failure cases was significantly greater than in those cases where therapy was completed without complications (P < .01). Multivariate analysis demonstrated that 2 or more insertion attempts were significantly associated with thrombus with subcutaneous edema. Results suggest that subsurface skin assessment for catheterization could prevent SPC failure.