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Early recognition of peripheral intravenous catheter failure using serial ultrasonographic assessments.
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- Author(s): Bahl A;Bahl A; Johnson S; Johnson S; Mielke N; Mielke N; Karabon P; Karabon P
- Source:
PloS one [PLoS One] 2021 Jun 16; Vol. 16 (6), pp. e0253243. Date of Electronic Publication: 2021 Jun 16 (Print Publication: 2021).- Publication Type:
Journal Article; Observational Study- Language:
English - Source:
- Additional Information
- Source: Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE
- Publication Information: Original Publication: San Francisco, CA : Public Library of Science
- Subject Terms:
- Abstract: Objective: Peripheral intravenous catheter (PIVC) failure occurs frequently, but the underlying mechanisms of failure are poorly understood. We aim to identify ultrasonographic factors that predict impending PIVC failure prior to clinical exam.
Methods: We conducted a single site prospective observational investigation at an academic tertiary care center. Adult emergency department (ED) patients who underwent traditional PIVC placement in the ED and required admission with an anticipated hospital length of stay greater than 48 hours were included. Ongoing daily PIVC assessments included clinical and ultrasonographic evaluations. The primary objective was to identify ultrasonographic PIVC site findings associated with an increased risk of PIVC failure. The secondary outcome was to determine if ultrasonographic indicators of PIVC failure occurred earlier than clinical recognition of PIVC failure.
Results: In July and August of 2020, 62 PIVCs were enrolled. PIVC failure occurred in 24 (38.71%) participants. Multivariate logistic regression demonstrated that the presence of ultrasonographic subcutaneous edema [AOR 7.37 (1.91, 27.6) p = 0.0030] was associated with an increased likelihood of premature PIVC failure. Overall, 6 (9.67%) patients had subcutaneous edema present on clinical exam, while 35 (56.45%) had subcutaneous edema identified on ultrasound. Among patients with PIVC failure, average time to edema detectable on ultrasound was 46 hours and average time to clinical recognition of failure was 67 hours (P = < 0.0001).
Conclusions: Presence of subcutaneous edema on ultrasound is a strong predictor of PIVC failure. Subclinical subcutaneous edema occurs early and often in the course of the PIVC lifecycle with a predictive impact on PIVC failure that is inadequately captured on clinical examination of the PIVC site. The early timing of this ultrasonographic finding provides the clinician with key information to better anticipate the patient's vascular access needs. Further research investigating interventions to enhance PIVC survival once sonographic subcutaneous edema is present is needed.
Competing Interests: The authors have declared that no competing interests exist. - References: Sci Rep. 2020 Jan 31;10(1):1550. (PMID: 32005839)
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Infect Dis Health. 2019 Aug;24(3):152-168. (PMID: 31005606)
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Br J Nurs. 2020 Apr 23;29(8):S44-S49. (PMID: 32324455)
Inquiry. 2019 Jan-Dec;56:46958019875562. (PMID: 31524024) - Publication Date: Date Created: 20210616 Date Completed: 20211115 Latest Revision: 20211115
- Publication Date: 20240104
- Accession Number: PMC8208550
- Accession Number: 10.1371/journal.pone.0253243
- Accession Number: 34133459
- Source:
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