Ultrasound-guided “short” midline catheters for difficult venous access in the emergency department: a retrospective analysis

Abstract

BackgroundAcutely ill patients admitted to the emergency department (ED) constantly require at least one fast and reliable peripheral intravenous (PIV) access. In many conditions (morbid obesity, underweight state, chronic diseases, intravenous drug abuse, adverse local conditions, etc.), PIV placement may be challenging.Ultrasound guidance is a useful tool for obtaining a peripheral intravenous access in the emergency department, particularly when superficial veins are difficult to identify by palpation and direct visualization, though standard peripheral intravenous cannulas are not ideal for this technique of insertion and may have limited duration.Long polyurethane catheters inserted with ultrasound guidance and direct Seldinger technique appear to have several advantages over short cannulas in terms of success of insertion and of duration.MethodsA retrospective analysis was conducted on all the ultrasound-guided peripheral venous accesses obtained by insertion of long polyurethane catheters in patients admitted to the emergency department of our university hospital during 1 year. The main indication to the procedure was the urgent need of a peripheral venous access in patients with superficial veins difficult to palpate and/or visualize. All relevant data concerning the insertion and the maintenance of these peripheral lines were collected from the chart.ResultsSeventy-six patients were included in this review. The success rate of insertion was 100 %, with an average of 1.57 punctures per each successful cannulation. The mean time needed for the complete procedure was 9.5 min. In 73 % of patients, the catheter was used for more than 1 week; a minority of catheters were removed prematurely for end of use. No major infective or thrombotic complication was reported.ConclusionsIn our experience, 8- to 10-cm-long polyurethane catheters may offer a fast and reliable peripheral venous access in the emergency department, if placed by ultrasound guidance and with the Seldinger technique. Further studies with prospective, randomized, and controlled design are warranted to confirm our results.

Standard long IV catheters versus extended dwell catheters: A randomized comparison of ultrasound-guided catheter survival

“…Based on a review of previous literature and prior clinical experience, the investigators assumed that the for the Standard Long IV catheter, the median survival time was 1 day. In addition, the median survival time was assumed to be 3 days for patients receiving the EDC catheter [13,17,[19][20][21]. Given these assumptions for median survival time between the two catheters, a minimum of 17 patients randomized to each catheter was required in order to provide 80% power to detect a significant effect.…”

“…These catheters have properties intermediate to PICC/midlines and standard peripheral IVs. Although very high success rates and improved longevity have been demonstrated with these devices, they require more steps akin to central line insertion compared to traditional US-guided IV placement and greater product costs [6,16,20].…”

Utilizing CT with Maximum Intensity Projection Reconstruction Bypassing CTA Improves Time to Groin Puncture in Large Vessel Occlusion Stroke Thrombectomy

“…There are many factors prior to CTA acquisition - including large bore intravenous line insertion - that can potentially delay advanced imaging and, ultimately, the time to GP. For patients with difficult intravenous access, an experienced personnel with an ultrasound guide may require up to 10 min or more to achieve intravenous access [6]. The maximum intensity projections (MIPs) of thin-slice NCCT further improve the sensitivity and accuracy of identifying acute thrombi of LVO in the anterior circulation by detecting “hyperdense signs” reliably, and CTA confirmation may not be necessary in selected cases [7].…”

Risk Factors for Difficult Peripheral Intravenous Cannulation. The PIVV2 Multicentre Case-Control Study

“…DPIVC has been reported to affect 10%-24% of hospitalized adults and is associated with higher rates of catheter failure, provoking more frequent catheter replacement [8]. This may produce serious complications associated with vascular access, such as phlebitis, extravasation, bruising, haemorrhages, catheter-associated infection and sepsis, thus aggravating morbidity [9,10].…”