The effect of vessel depth, diameter, and location on ultrasound-guided peripheral intravenous catheter longevity

Am J Emerg Med. 2012 Sep;30(7):1134-40. doi: 10.1016/j.ajem.2011.07.027. Epub 2011 Nov 10.


Introduction: 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.

Conclusion: 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.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Catheterization, Peripheral* / adverse effects
  • Catheterization, Peripheral* / methods
  • Catheterization, Peripheral* / statistics & numerical data
  • Equipment Failure / statistics & numerical data
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Retrospective Studies
  • Time Factors
  • Ultrasonography, Interventional* / adverse effects
  • Ultrasonography, Interventional* / statistics & numerical data
  • Veins / anatomy & histology
  • Young Adult