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"In critically ill pediatric patients with difficult vascular access, ultrasound-guided long peripheral intravenous catheters provide an alternative to traditional approach standard-sized intravenous catheters with improved longevity, lower failure rates, and reduced need for additional vascular interventions" Dachepally et al (2023).
Ultrasound-guided long peripheral intravenous catheters

Abstract:

Background: Critically ill pediatric patients can have difficulty with establishing and maintaining stable vascular access. A long-dwelling peripheral intravenous catheter placement decreases the need for additional vascular interventions.

Aim: The study sought to compare longevity, catheter-associated complications, and the need for additional vascular interventions when using ultrasound-guided longer peripheral intravenous catheters comparing to a traditional approach using standard-sized peripheral intravenous catheters in pediatric critically ill patients with difficult vascular access.

Methods: This single-center retrospective cohort study included children 0-18 years of age with difficult vascular access admitted to the pediatric intensive care unit between 01/01/2018- 06/01/2021.

Results: 187 placements were included in the study, with 99 ultrasound-guided long intravenous catheters placed and 88 traditionally placed standard-sized intravenous catheters. In the univariate analysis, patients in the traditional approach were at a higher risk of intravenous failure compared to those in the ultrasound-guided approach (HR=2.20, 95% CI [1.45-3.34], P=.001), with median intravenous survival times of 108 and 219 hours, respectively. Adjusting for age, patients in the traditional approach remained at higher risk of intravenous failure (HR=1.99, 95% CI: [1.28-3.08], P = .002). Adjusting for hospital length of stay, patients in the ultrasound-guided approach were less likely to have additional peripheral intravenous access placed during hospitalization (OR= 0.39, 95% CI [0.18-0.85] P=.017).

Conclusion: In critically ill pediatric patients with difficult vascular access, ultrasound-guided long peripheral intravenous catheters provide an alternative to traditional approach standard-sized intravenous catheters with improved longevity, lower failure rates, and reduced need for additional vascular interventions.

Reference:

Dachepally R, Garcia AD, Liu W, Flechler C, Hanna WJ. Assessing the utility of ultrasound-guided vascular access placement with longer catheters in critically ill pediatric patients. Paediatr Anaesth. 2023 Feb 8. doi: 10.1111/pan.14645. Epub ahead of print. PMID: 36756680.