Peripheral IV Versus Extended Dwell Catheter Longevity in the PICU: Single-Center Retrospective Cohort, 2023–2024

OBJECTIVES: To review the longevity of extended dwell catheters (EDCs) vs. peripheral IV catheters (PIVs) in pediatric critical care and explore factors associated with catheter duration. DESIGN: Retrospective cohort study between September 2023 and August 2024. SETTING: A single mixed cardiac and general PICU in an academic health care center in Ottawa, Canada. PATIENTS: A total of 400 vascular access catheters were included, comprising 329 PIVs and 71 EDCs in 238 unique patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Median (interquartile range [IQR]) unadjusted catheter dwell times were 4.6 days (IQR, 2.8-7.9 d) for EDCs and 2.3 days (IQR, 1.2-4.1 d) for PIVs. In an adjusted mixed-effects multivariable regression model, EDCs as opposed to PIVs were associated with 62% greater longevity (1.62 [95% CI, 1.10-2.37]). Factors associated with increased longevity included use of upper limb location (1.49 [95% CI, 1.07-2.07]) and sedation combined with acute invasive mechanical ventilation (2.12 [95% CI, 1.47-3.05]). A sensitivity analysis of only failed devices failed to identify an associated increase or decrease in longevity for EDCs (1.38 [95% CI, 0.80-2.37]), but close inspection of the estimate and upper limit of the 95% CI shows that we are unable to exclude the possibility of more than doubling of longevity. We also failed to demonstrate an association between the proportion of catheters still functional at the time of removal and catheter type: PIV, 26% (95% CI, 21-31%) vs. EDC, 30% (95% CI, 20-42%). CONCLUSIONS: In our center, 2023-2024, use of EDCs as opposed to PIVs in PICU cases was associated with longer duration of use, suggesting preferred use of EDCs in patients requiring medium-term IV access, but not meeting criteria for central access. Further prospective studies are necessary to evaluate broader use of EDCs and optimum insertion practices.