PC3096: Ultrasound-guided Vascular Access with Longer Catheters Improves IV Longevity and Minimizes Additional Intervention in Critically Ill Pediatric Patients

Background: Establishing and maintaining stable vascular access in critically ill pediatric patients can be challenging, with early IV catheter failure being a common complication. The objective of this study was to compare IV longevity, success rate to completion of therapy, and catheter-associated complications of ultrasound guided longer IV catheters with a traditional approach IV placement using standard-sized catheters in critically ill patients deemed to have difficult IV access.

Methods: Single center retrospective observational study of patients admitted to a combined unit of pediatric cardiac and pediatric critical care between 01/01/2018-06/01/2021. Traditional IV placement included manual placement or use of vein illuminator with standard catheter sized (24 g 19 mm, 22 g 25 mm, 20 g 32 mm). U/S guided PIVs placed were of longer length (24 g 32 mm, 22 g 45 mm, 20 g 45 mm). Failure to place an IV by bed side nurse would notify Vascular access team or physician on call to place IV

Results: A total of 187 placements were enrolled in the study which included 99 IV placements in U/S guided group and 88 IV placements in the traditional group. Kaplan-Meier analysis exhibited median IV survival rates of 219 and 108 hours in the U/S guided and traditional groups, respectively. Adjusting for age, patients in the short catheter group remained at higher risk of IV failure. (HR = 1.99, 95% CI 1.28 to 3.08, p = 0.002). Multinominal regression analysis showed patients with an U/S-guided approach were also less likely to have additional PIV access placed during hospitalization (OR 2.8(1.3-6.0), p=0.010)

Conclusion: Ultrasound guided longer IV catheters represent a viable and favorable alternative to the traditional IV placement in critically ill patients with difficult access. This approach improved IV longevity and was associated with both lower failure rates and decrease need of additional IV intervention.