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Ultrasound assessment of peripheral IV catheters

Abstract:

Objective: Establish the feasibility of pediatric intensive care unit (PICU) nurse-directed ultrasound assessment (UA) of peripheral intravenous (PIV) catheters, compare the results of UA to traditional assessment (TA), and determine PIV survival after UA.

Design: Prospective observational cohort study.

Setting: PICU within a children’s hospital.

Patients: PICU patients with a PIV.

Interventions: None.

Measurements and main results: Eight nurses performed UA on 131 PIVs in 85 patients. Median age was 3.0 years (IQR 1.0-13.8) and median weight was 15.0 kg (IQR 9.6-59.3). The most common PIV location was the arm (43%) and extravasation occurred in 15% of PIVs. Agreement between TA and UA was moderate with a Kappa of 0.47 (95% CI 0.28-0.66). Nursing confidence in the UA was significantly higher than TA (92% vs 21% very confident, p < 0.0001). In 106 PIVs with a UA that indicated the PIV was intravascular (i.e. negative UA), the median survival was 50.0 h (IQR 21.8-100.3).

Conclusions: Nurses can perform UA of PIV status in PICU patients and express greater confidence in the findings of UA than TA. Further study is necessary to determine the impact of UA on the rate of PIV complications.

Reference:

Good RJ, Diaz E, Thomas R, Wathen B, Carpenter TC. Ultrasound assessment of peripheral intravenous catheters by nurses in the pediatric intensive care unit. J Vasc Access. 2021 Jun 12:11297298211024805. doi: 10.1177/11297298211024805. Epub ahead of print. PMID: 34121499.