Abstract:
Objective: Ultrasound-guided peripheral intravenous (USPIV) catheters are being placed in emergency department (ED) patients with increasing frequency. USPIV catheters have been shown to improve the success rates of cannulation. It is unknown what the long-term effect of USPIV placement will be on fistula creation in chronic kidney disease (CKD) patients considering these ultrasound-guided peripheral lines often target the same deeper vessels used for fistulas. This study aimed to survey whether emergency medicine programs place restrictions on USPIV placement in patients with CKD stages 3-5.
Methods: This was a survey study encompassing all 110 emergency ultrasound fellowship directors in the United States at the time the survey was conducted. Data was collected on an anonymous and voluntary basis. The primary outcome was the number of programs with restrictions on USPIV placement in patients with CKD stage 3 or greater.
Results: Of the 56 programs that responded, 21% reported having policies limiting which patients were appropriate for USPIV. Despite this, only one program reported placing restrictions on USPIV in CKD stage 3 or greater (p < 0.0001).
Conclusions: Emergency departments do not have or follow restrictions placed on USPIV placement in patients with CKD stage 3 or greater. The use of these veins in the ED may result in thrombosis as well as inflammation and permanent scarring which could negatively impact the ability to utilize those vessels for fistula creation. Future studies are needed to further characterize the impact of USPIV on fistula creation.
Reference:Icken L, Sharma EV, Schrock JW, Lally AP, Tate SJ, Tabbut MP, Jones RA. Ultrasound-guided peripheral intravenous access in chronic kidney disease patients. J Vasc Access. 2021 Apr 30:11297298211012212. doi: 10.1177/11297298211012212. Epub ahead of print. PMID: 33926286.
Ultrasound peripheral IV access in chronic kidney disease patients is a topic in which little evidence exists. This study indicates the need for more evidence with regard to the use of ultrasound on deep arm vessels that may impact on future fistula formation.
The authors state "The use of these veins in the ED may result in thrombosis as well as inflammation and permanent scarring which could negatively impact the ability to utilize those vessels for fistula creation".