The Impact of Peripheral Intravenous Catheter Insertion Technique and Catheter-to-Vein Ratio on Postinsertion Failure.
catheter
catheter-to-vein ratio
failure
intravenous
peripheral
postinsertion
ultrasonographically guided
Journal
The Journal of emergency medicine
ISSN: 0736-4679
Titre abrégé: J Emerg Med
Pays: United States
ID NLM: 8412174
Informations de publication
Date de publication:
05 2023
05 2023
Historique:
received:
26
09
2022
revised:
23
12
2022
accepted:
17
02
2023
medline:
19
5
2023
pubmed:
11
4
2023
entrez:
10
4
2023
Statut:
ppublish
Résumé
Peripheral intravenous catheter (PIVC) postinsertion failure rates are unacceptable. Ultrasonography is an adjunctive tool that may improve PIVC utilization success. Determine if ultrasonographically guided (USG) PIVCs placed in the emergency department (ED) significantly decreases postinsertion failure rate, increases utility time, and decreases postremoval complication rate. Determine if catheter-to-vein ratio (CVR) predicts postinsertion failure. Participants were randomized to either standard or USG cohort. Data collection included participant and PIVC characteristics, vein measurements, postinsertion failure, and postremoval complication. Chi-square analysis compared postinsertion failure rates. Group t-test compared utility times. Postremoval complication rates were compared with standard rate analysis. The receiver operating characteristic curve was calculated to determine if CVR could predict postinsertion failure. An enrollment of 582 was estimated. A total of 223 patients were enrolled, with 222 PIVCs investigated. Standard cohort included 116 PIVCs and USG cohort included 106 PIVCs. A total of 212 vein diameters were analyzed. USG PIVC insertion did not result in fewer postinsertion failures (p = 0.654) or longer utility time (p = 0.808). Postremoval complications were not significantly lower (p = 0.414). Receiver operating characteristic curve showed a cut-off CVR of ∼ 0.21. Area under the curve was 0.621 (p = 0.063, 95% confidence interval 0.508-0.734). The USG technique did not decrease postinsertion failure rate, increase utility time, or significantly decrease postremoval complication rate. A CVR predictive of postinsertion failure could not be determined.
Sections du résumé
BACKGROUND
Peripheral intravenous catheter (PIVC) postinsertion failure rates are unacceptable. Ultrasonography is an adjunctive tool that may improve PIVC utilization success.
OBJECTIVES
Determine if ultrasonographically guided (USG) PIVCs placed in the emergency department (ED) significantly decreases postinsertion failure rate, increases utility time, and decreases postremoval complication rate. Determine if catheter-to-vein ratio (CVR) predicts postinsertion failure.
METHODS
Participants were randomized to either standard or USG cohort. Data collection included participant and PIVC characteristics, vein measurements, postinsertion failure, and postremoval complication. Chi-square analysis compared postinsertion failure rates. Group t-test compared utility times. Postremoval complication rates were compared with standard rate analysis. The receiver operating characteristic curve was calculated to determine if CVR could predict postinsertion failure. An enrollment of 582 was estimated.
RESULTS
A total of 223 patients were enrolled, with 222 PIVCs investigated. Standard cohort included 116 PIVCs and USG cohort included 106 PIVCs. A total of 212 vein diameters were analyzed. USG PIVC insertion did not result in fewer postinsertion failures (p = 0.654) or longer utility time (p = 0.808). Postremoval complications were not significantly lower (p = 0.414). Receiver operating characteristic curve showed a cut-off CVR of ∼ 0.21. Area under the curve was 0.621 (p = 0.063, 95% confidence interval 0.508-0.734).
CONCLUSION
The USG technique did not decrease postinsertion failure rate, increase utility time, or significantly decrease postremoval complication rate. A CVR predictive of postinsertion failure could not be determined.
Identifiants
pubmed: 37037760
pii: S0736-4679(23)00060-4
doi: 10.1016/j.jemermed.2023.02.011
pii:
doi:
Types de publication
Randomized Controlled Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
564-573Informations de copyright
Copyright © 2023 Elsevier Inc. All rights reserved.