title: The effect of vessel depth, diameter, and location on ultrasound-guided peripheral intravenous catheter longevity.
abstract: BACKGROUND
  Ultrasound-guided peripheral intravenous catheters (USGPIVs) have been observed to have poor durability. The current study sets out to determine whether vessel characteristics (depth, diameter, and location) predict USGPIV longevity.
  
  
  METHODS
  A secondary analysis was performed on a prospectively gathered database of patients who underwent USGPIV placement in an urban, tertiary care emergency department. All patients in the database had a 20-gauge, 48-mm-long catheter placed under ultrasound guidance. The time and reason for USGPIV removal were extracted by retrospective chart review. A Kaplan-Meier survival analysis was performed.
  
  
  RESULTS
  After 48 hours from USGPIV placement, 32% (48/151) had failed prematurely, 24% (36/151) had been removed for routine reasons, and 44% (67/151) remained in working condition yielding a survival probability of 0.63 (95% confidence interval [CI], 0.53-0.70). Survival probability was perfect (1.00) when placed in shallow vessels (<0.4 cm), moderate (0.62; 95% CI, 0.51-0.71) for intermediate vessels (0.40-1.19 cm), and poor (0.29; 95% CI, 0.11-0.51) for deep vessels (≥1.2 cm); P < .0001. Intravenous survival probability was higher when placed in the antecubital fossa or forearm locations (0.83; 95% CI, 0.69-0.91) and lower in the brachial region (0.50; 95% CI, 0.38-0.61); P = .0002. The impact of vessel depth and location was significant after 3 hours and 18 hours, respectively. Vessel diameter did not affect USGPIV longevity.
  
  
  CONCLUSIONS
  Cannulation of deep and proximal vessels is associated with poor USGPIV survival. Careful selection of target vessels may help improve success of USGPIV placement and durability.
authors.affiliation: Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA. matthewfields@gmail.com
authors.forename: J Matthew
authors.initials: JM
authors.lastname: Fields
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Dean
authors.forename: Raleigh W
authors.initials: RW
authors.lastname: Todman
authors.forename: Arthur K
authors.initials: AK
authors.lastname: Au
authors.forename: Kenton L
authors.initials: KL
authors.lastname: Anderson
authors.forename: Bon S
authors.initials: BS
authors.lastname: Ku
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Pines
authors.forename: Nova L
authors.initials: NL
authors.lastname: Panebianco
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D004868:Equipment Failure / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000706:statistics & numerical data; D014680:Veins / Q000033:anatomy & histology; D055815:Young Adult