Assessing the utility of ultrasound‐guided vascular access placement with longer catheters in critically ill pediatric patients

Background Critically ill pediatric patients can have difficulty with establishing and maintaining stable vascular access. A long‐dwelling peripheral intravenous catheter placement decreases the need for additional vascular interventions. Aim The study sought to compare longevity, catheter‐associated complications, and the need for additional vascular interventions when using ultrasound‐guided longer peripheral intravenous catheters comparing to a traditional approach using standard‐sized peripheral intravenous catheters in pediatric critically ill patients with difficult vascular access. Methods This single‐center retrospective cohort study included children 0–18 years of age with difficult vascular access admitted to the pediatric intensive care unit between 01/01/2018–06/01/2021. Results One hundred and eighty seven placements were included in the study, with 99 ultrasound‐guided long intravenous catheters placed and 88 traditionally placed standard‐sized intravenous catheters. In the univariate analysis, patients in the traditional approach were at a higher risk of intravenous failure compared to those in the ultrasound‐guided approach (HR = 2.20, 95% CI [1.45–3.34], p = .001), with median intravenous survival times of 108 and 219 h, respectively. Adjusting for age, patients in the traditional approach remained at higher risk of intravenous failure (HR = 1.99, 95% CI: [1.28–3.08], p = .002). Adjusting for hospital length of stay, patients in the ultrasound‐guided approach were less likely to have additional peripheral intravenous access placed during hospitalization (OR = 0.39, 95% CI [0.18–0.85] p = .017). Conclusion In critically ill pediatric patients with difficult vascular access, ultrasound‐guided long peripheral intravenous catheters provide an alternative to traditional approach standard‐sized intravenous catheters with improved longevity, lower failure rates, and reduced need for additional vascular interventions.