Long peripheral catheters for intravenous access in adults and children: A systematic review of the literature

Abstract

Background: Long peripheral catheters are peripheral intravenous catheters of 6–15 cm in length. They are commonly inserted into the forearm, antecubital fossa or upper arm using a direct Seldinger technique. They have proven to be valuable for peripheral intravenous catheters, particularly in patients with difficult intravenous access. Methods: We conducted a systematic review of studies reporting the use of long peripheral catheters. The following keywords were used: ‘long’, ‘Seldinger’, ‘guidewire’, ‘peripheral’, ‘venous’, ‘intravenous’, ‘IV’, ‘vascular’, ‘cannula’ and ‘catheter’. Results: Three hundred forty-one publications were identified; 16 were included in the systematic review. There were 11 adult studies and 5 paediatric studies documenting 1288 long peripheral catheters in 1271 patients. Majority of studies (12/16) were conducted in acute care settings, (emergency department, n = 6; intensive care unit, n = 3; high dependency unit, n = 1; surgical unit, n = 2). The most frequently studied long peripheral catheter was 8 cm in length and 20 G in size. Nine studies recruited patients with difficult intravenous access; 11 studies used ultrasound guidance. Insertion success rate and mean procedural time ranged between 86% and 100% and 8 and 16.8 minutes, respectively. Average catheter duration ranged between 4 and 14.7 days (mean) and 1.1 and 9 days (median). Catheter failure occurred in 4.3–52.5% of long peripheral catheters, with leakage, infiltration and dislodgement being the most frequent causes of failure. In 3 randomised controlled trials, long peripheral catheters outperformed peripheral intravenous catheters in terms of duration and failure rate. Conclusion: Long peripheral catheters are safe and reliable in both adults and children. In addition, long peripheral catheters may provide improved quality of care over peripheral intravenous catheters for multi-day intravenous therapy.

Long peripheral catheters and midline catheters: Insights from a survey of vascular access specialists

“…We found large variance in the nomenclature and use of 6–15 cm peripheral IV devices in the medical literature. 2 , 3 Since these devices are relatively novel, there are no official guidelines to standardise their terminology and use. Therefore, we suggested the classification of peripheral devices in PIVCs, LPCs and MCs based on the length of the catheter and tip position.…”

“…We have previously highlighted the aspects surrounding the nomenclature and use of long peripheral devices in our editorial and systematic review published in The Journal of Vascular Access. 2,3 Moreover, we presented and discussed these findings at the 2019 Association of Vascular Access (AVA) Annual Scientific Meeting.…”

“…Patients requiring medium-term IV therapy (1–4 weeks), or with difficult venous access, can now receive treatment via long peripheral devices such as long peripheral catheters (LPCs) and midline catheters (MCs). 1–3…”

“…securement; need for heparinised lock, etc.). 3 Regarding the use of ultrasound, although LPCs and MCs can be safely placed without ultrasound, the use of ultrasound-guidance is generally recommend as these longer devices have proved particularly useful for accessing deep veins in patients with DIVA. 3…”

“…Despite the challenges highlighted above, current evidence suggests that LPCs and MCs are safe and reliable in both adults and children, providing improved quality of care over PIVCs for multi-day intravenous therapy. 3,6…”