Peripheral IV Catheter Longevity With Ultrasound Guidance in the PICU: Single-Center Retrospective Cohort, 2016–2018

OBJECTIVES: To compare associated outcomes between ultrasound-guided peripheral IV catheter (USGPIV) insertion and device longevity in critically ill children. DESIGN: Retrospective observational cohort study. SETTING: Tertiary medical-surgical pediatric PICU with cardiac patients. PATIENTS: Patients admitted to the PICU requiring peripheral vascular access between January 1, 2016, and October 1, 2018. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We identified patients who underwent USGPIV and landmark-guided peripheral IV catheters (LMGPIV) placed within 2 weeks of a USGPIV, and made comparisons between the procedures. There were 507 USGPIV and 292 LMGPIV placements. Of these, 334 USGPIV and 278 LMGPIV had longevity data. Log-rank analysis with median (interquartile range, IQR) data showed an associated greater catheter longevity in USGPIVs vs. LMGPIVs, respectively: 5 days (IQR, 2-9 d) vs. 3 days (IQR, 1-4 d), p value of less than 0.001. When restricted to either patients admitted with cardiac disease or those with known difficult vascular access, the association between USGPIVs and LMGPIVs and greater longevity remained, respectively: cardiac cases, 5 days (IQR, 2-9 d) vs. 3 days (IQR, 2-6 d); p = 0.038 and difficult access, 5 days (IQR, 2-9 d) vs. 2 days (IQR, 1-4 d), p value of less than 0.001. CONCLUSIONS: In this single-center experience of using USGPIV placement over 28 months (2016-2018), USGPIV placement was associated with greater catheter longevity. These findings suggest that USGPIV placement is potentially a means for improving PIV insertion and maintenance.