Student University of Hawaii, John A. Burns School of Medicine Honolulu, Hawaii, United States
Background: Peripheral intravenous catheters (PIVC) are commonly used in pediatric patients, but catheter failure remains a significant issue. Ultrasound-guided PIVC placement has improved success rates, but the impact of catheter length on outcomes remains unclear. This study compares the longevity and complications of long versus short USG PIVCs in hospitalized pediatric patients.
Objective: To evaluate whether long USG PIVCs have superior longevity and fewer extravasations compared to short USG PIVCs in a pediatric hospital setting.
Design/Methods: This retrospective chart review analyzed pediatric patients who received USGPIV placement at Kapiʻolani Medical Center for Women and Children between 11/01/2021 and 07/01/2023. Patients under 18 were included, with catheter length categorized as short (1.25”) or long (1.75”). Primary outcomes were extravasation rate and catheter lifespan. Exclusion criteria included duplicate/missing data, non-ultrasound PIVs, placements outside the institution, patients < 6 months old, certain catheter gauges (17, 18/20, 23, 26), and placements exceeding 14 days. Mixed logistic regression adjusted for key variables to calculate ORs and aORs. Cox proportional hazards regression assessed catheter survival and extravasation risk. Analyses were conducted using SAS 9.4, with p<.05 considered significant.
Results: The median patient age was 5 years, with a median weight of 16.9 kg. Most USGPIVs were placed in the forearm (84.21%), utilized short catheters (91.36%), and were inserted at a depth of 0.5–1.0 cm (56.43%). Overall, 9.7% (n=380) of catheters were discontinued due to extravasation.
Younger age, lower weight, and longer catheter dwell time were associated with a higher risk of extravasation. Long catheters were 48% more likely to extravasate than short catheters (OR 1.48, 95% CI: 1.06–2.07). See Table 2 for further comparisons.
Despite a higher extravasation rate, long catheters had a longer median indwelling lifespan than short catheters (Figure 1).
Conclusion(s): Long PIV catheters (≥1.75”) placed under ultrasound guidance had a longer lifespan than short catheters (≤1.25”) but were associated with a slightly higher extravasation rate. Future research should focus on factors influencing these outcomes, including securement techniques, medication type, and patient movement. Standardized catheter classification is needed to minimize misclassification bias. Despite the increased extravasation risk, long catheters may reduce unnecessary venipunctures in hospitalized pediatric patients requiring USGPIVs.
