USGPIV Longevity in Pediatric Patients
Evidence Spotlight: USGPIV Longevity in Pediatric Patients
Study: Desai K, Vinograd AM, Abbadessa MKF, Chen AE. Longevity and Complication Rates of Ultrasound Guided Versus Traditional Peripheral Intravenous Catheters in a Pediatric Emergency Department. Journal of the Association for Vascular Access. 2018;23(3):149–154. doi:10.1016/j.java.2018.06.002.
Why this study matters
Much of the conversation around ultrasound-guided peripheral IV access focuses on successful insertion: fewer attempts, faster cannulation, and improved access in patients with difficult intravenous access.
But successful insertion is only part of the story.
A peripheral IV also needs to remain functional long enough to provide the prescribed therapy. Previous literature had raised concerns that ultrasound-guided PIVs—particularly those placed in deeper vessels—might have poorer durability.
Desai and colleagues specifically examined that question by comparing USGPIV longevity and complications with traditionally placed peripheral IVs in pediatric patients.
What they studied
The study was conducted in a large urban pediatric emergency department caring for approximately 97,000 patients annually, including a substantial population of children with chronic illnesses and difficult IV access.
Researchers compared:
300 USGPIV encounters
with
552 traditional PIV encounters.
USGPIV placement wasn't restricted to physicians. Nurses, residents, fellows, and attending physicians participated. Nurses and pediatric residents completed a four-hour program combining didactic and hands-on training, while physicians authorized for placement had completed bedside-ultrasound training.
Ultrasound access was implemented alongside structured education.
The patient populations make the results particularly interesting
The USGPIV group wasn't necessarily the easier group.
55% of patients receiving USGPIVs reported a history of difficult access, compared with only 7.2% of the traditional PIV group.
And among patients with successful USGPIV placement, many had already undergone traditional attempts during that encounter: 55% had one previous traditional attempt and 38% had more than one.
Yet the ultrasound-guided lines performed very well.
The major finding: USGPIVs lasted longer
Overall mean survival was:
USGPIV: 73 hours
Traditional PIV: 38 hours
The difference was statistically significant (P < .0001).
The Kaplan-Meier analysis—which censored lines removed because they were no longer needed or were lost to follow-up—also showed significantly longer survival for ultrasound-guided lines:
USGPIV: 143 hours
Traditional PIV: 89 hours
P < .001.
The survival curves on page 4 make the difference especially easy to see: the USGPIV curve remains above the traditional PIV curve across much of the observation period.
Longer dwell did NOT come with significantly more complications
Among catheters with complete follow-up, complications occurred in approximately:
34% of USGPIVs
versus
32% of traditional PIVs.
There was no statistically significant difference between the groups.
Common failures were similar and included infiltration, unintended dislodgement, occlusion, and phlebitis.
In this study, CCE noted:
USGPIVs placed in a population with substantially more difficult access demonstrated longer survival without a significant increase in overall complications compared with traditional PIVs.
Why might the USGPIVs have lasted longer?
The authors suggest that durability may be influenced by provider training, insertion technique, clinician experience, and catheter length.
Importantly, the majority of USGPIVs at this institution were longer than the traditional PIVs. The authors specifically raise the theoretical advantage of having more catheter securely positioned within the vessel as a possible contributor to longevity.
CCE believes: Reaching the vessel isn't enough.
Successful USGPIV placement requires selecting an appropriate vessel and an appropriate catheter for its depth so sufficient catheter remains within the vessel.
*This study does not establish catheter length as the reason for improved survival
Important limitations
This wasn't a randomized controlled trial, and the groups were substantially different.
USGPIV placements were self-reported by clinicians, which creates potential reporting bias. Follow-up wasn't complete for every catheter. The traditional PIV comparison group was also sampled differently from the USGPIV group.
And perhaps most importantly, the authors acknowledge that USGPIV longevity may be institution-dependent. Training, technique, experience, catheter selection and local practice could all influence outcomes.
CCE Practice Takeaway:
Successful vascular access isn't just about getting the catheter in. It's about placing the right catheter, in the right vessel, using a technique that supports reliable therapy after insertion.
USGPIV should not be viewed simply as a rescue technique for obtaining access after repeated failure. When paired with appropriate training, vessel assessment, catheter selection, and insertion technique, it can provide durable peripheral vascular access for patients with difficult access.
