Early recognition of peripheral intravenous catheter failure using serial ultrasonographic assessments.

<h4>Objective</h4>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.<h4>Methods</h4>We conduc...

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Autores principales:	Amit Bahl, Steven Johnson, Nicholas Mielke, Patrick Karabon
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/fb8a762ec4a749a5a054ab0e939a97e9
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spelling	oai:doaj.org-article:fb8a762ec4a749a5a054ab0e939a97e92021-12-02T20:10:34ZEarly recognition of peripheral intravenous catheter failure using serial ultrasonographic assessments.1932-620310.1371/journal.pone.0253243https://doaj.org/article/fb8a762ec4a749a5a054ab0e939a97e92021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0253243https://doaj.org/toc/1932-6203<h4>Objective</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusions</h4>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.Amit BahlSteven JohnsonNicholas MielkePatrick KarabonPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0253243 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Amit Bahl Steven Johnson Nicholas Mielke Patrick Karabon Early recognition of peripheral intravenous catheter failure using serial ultrasonographic assessments.
description	<h4>Objective</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusions</h4>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.
format	article
author	Amit Bahl Steven Johnson Nicholas Mielke Patrick Karabon
author_facet	Amit Bahl Steven Johnson Nicholas Mielke Patrick Karabon
author_sort	Amit Bahl
title	Early recognition of peripheral intravenous catheter failure using serial ultrasonographic assessments.
title_short	Early recognition of peripheral intravenous catheter failure using serial ultrasonographic assessments.
title_full	Early recognition of peripheral intravenous catheter failure using serial ultrasonographic assessments.
title_fullStr	Early recognition of peripheral intravenous catheter failure using serial ultrasonographic assessments.
title_full_unstemmed	Early recognition of peripheral intravenous catheter failure using serial ultrasonographic assessments.
title_sort	early recognition of peripheral intravenous catheter failure using serial ultrasonographic assessments.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/fb8a762ec4a749a5a054ab0e939a97e9
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Early recognition of peripheral intravenous catheter failure using serial ultrasonographic assessments.

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