Ultrasound‐guided long peripheral catheter placement in adults with difficult intravenous access in the emergency department

Abstract Background Reliable vascular access is difficult to establish in patients with difficult intravenous access (DIVA) in the emergency department (ED). Long peripheral catheters (LPCs) offer durable peripheral access in selected patients. The feasibility, safety, and effectiveness of LPCs in patients with DIVA in the ED remain unclear. We prospectively evaluated the clinical outcomes, complication rates, and procedural efficiency of ultrasonography‐guided LPC placement in patients undergoing DIVA in the ED. Methods This single‐centre prospective observational study was conducted between December 2024 and April 2025 in the ED of a tertiary university‐affiliated hospital in China. Adults with DIVA who met the predefined clinical criteria underwent ultrasonography‐guided insertion of a 10‐cm LPC by trained nurses. The outcomes included technical and first‐attempt success rates, procedure duration, catheter dwell time, and catheter‐related events. Results A total of 145 patients underwent LPC placement, with technical success in all patients and first‐attempt success in 55.9% of the patients. The mean procedure duration was 30 ± 13 min, and the median catheter‐dwelling time was 12 days. Catheter‐related events occurred in 20.7% of patients, including occlusion (6.2%), infiltration (5.5%), and ultrasound‐confirmed catheter‐related thrombosis (4.8%). No catheter‐related bloodstream infection was identified during follow‐up. In 93.8% of patients, the initially placed LPC remained functional without replacement. Conclusion Ultrasound‐guided LPC placement is feasible in selected adult patients with DIVA in ED and provides a median dwell time of 12 days. Comparative studies are required to establish the relative benefits, safety, and appropriate clinical indications of these vascular access strategies.