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Extended-Dwell Peripheral Intravenous Catheters: A Novel Approach to Decreasing Central Venous Catheter Utilization
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A6819 - Extended-Dwell Peripheral Intravenous Catheters: A Novel Approach to Decreasing Central Venous Catheter Utilization
Author Block: S. Zarbiv, A. Manasia, S. Griffiths, P. Maddireddy, M. Bamajboor, R. Freeman, K. Wiley, J. Albano, A. Brito, G. Lee, C. Wells, C. Valcorza, E. Hannon, R. Kohli-Seth; Institute for Critical Care Medicine, Mount Sinai Hospital, New York, NY, United States.
Rationale:
Standard peripheral intravenous catheters (PIVs) have an inherently short dwell time of 72-96 hours, and their placement is often hindered by patient factors such as edema, obesity, and sclerotic superficial veins. PIVs placed under ultrasound guidance are prone to failure in up to 50% of patients. Central venous catheters (CVCs), despite their high incidence of complications, have traditionally been placed for those patients in whom PIVs are difficult to obtain.
Extended-Dwell Peripheral Intravenous Catheters (ED-PIVs) are FDA approved peripheral devices that have a dwell time of 29 days, and are ideal for patients with difficult peripheral access who require prolonged intravenous therapy. Inserted under ultrasound guidance with sterile technique, ED-PIVs are placed using advanced Seldinger technique.
Methods:
The Institute for Critical Care Medicine (ICCM), which oversees operations, quality, and safety in all adult ICUs within our 1172 bed quaternary care hospital, implemented a Peripheral Vascular Access Service (PVAS). PVAS is an intensivist-directed, nurse-led team which specializes in placing ED-PIVs. This team consults on all lines placed in the hospital and ensures that the right patient, gets the right access at the right time, in the right setting by the right clinician. We retrospectively analyzed CVC utilization for ICU patients and across the hospital, comparing the first six months of PVAS (April 2017 - September 2017) to same period in 2016 A two sample t-test was used to determine statistical significance. The number of ED-PIVs inserted by PVAS, with insertion-related complications, were also recorded and analyzed.
Results:
In the ICU and hospital-wide, there was a 26.5% (48.8% to 35.9%, P = 0.0006) and 17.2% (20.6% to 17.1%, P = 0.0002) decrease between the pre-PVAS and post-PVAS catheter utilization, respectively. Of the 292 ED-PIV insertions by PVAS, 272 (93.4%) were successfully placed with one attempt. Insertion-related complications occurred in 6 (2.1%) patients. Five (1.8%) developed hematomas and 1 (0.36%) patient had excessive bleeding not requiring transfusion. None of these complications required removal of the device.
Conclusion:
Implementation of PVAS and use of ED-PIVs has demonstrated a reduction in CVC utilization, with low rates and severity of insertion-related complications. While further studies are required, this analysis provides promising results for the introduction of similar services in other institutions.
Author Block: S. Zarbiv, A. Manasia, S. Griffiths, P. Maddireddy, M. Bamajboor, R. Freeman, K. Wiley, J. Albano, A. Brito, G. Lee, C. Wells, C. Valcorza, E. Hannon, R. Kohli-Seth; Institute for Critical Care Medicine, Mount Sinai Hospital, New York, NY, United States.
Rationale:
Standard peripheral intravenous catheters (PIVs) have an inherently short dwell time of 72-96 hours, and their placement is often hindered by patient factors such as edema, obesity, and sclerotic superficial veins. PIVs placed under ultrasound guidance are prone to failure in up to 50% of patients. Central venous catheters (CVCs), despite their high incidence of complications, have traditionally been placed for those patients in whom PIVs are difficult to obtain.
Extended-Dwell Peripheral Intravenous Catheters (ED-PIVs) are FDA approved peripheral devices that have a dwell time of 29 days, and are ideal for patients with difficult peripheral access who require prolonged intravenous therapy. Inserted under ultrasound guidance with sterile technique, ED-PIVs are placed using advanced Seldinger technique.
Methods:
The Institute for Critical Care Medicine (ICCM), which oversees operations, quality, and safety in all adult ICUs within our 1172 bed quaternary care hospital, implemented a Peripheral Vascular Access Service (PVAS). PVAS is an intensivist-directed, nurse-led team which specializes in placing ED-PIVs. This team consults on all lines placed in the hospital and ensures that the right patient, gets the right access at the right time, in the right setting by the right clinician. We retrospectively analyzed CVC utilization for ICU patients and across the hospital, comparing the first six months of PVAS (April 2017 - September 2017) to same period in 2016 A two sample t-test was used to determine statistical significance. The number of ED-PIVs inserted by PVAS, with insertion-related complications, were also recorded and analyzed.
Results:
In the ICU and hospital-wide, there was a 26.5% (48.8% to 35.9%, P = 0.0006) and 17.2% (20.6% to 17.1%, P = 0.0002) decrease between the pre-PVAS and post-PVAS catheter utilization, respectively. Of the 292 ED-PIV insertions by PVAS, 272 (93.4%) were successfully placed with one attempt. Insertion-related complications occurred in 6 (2.1%) patients. Five (1.8%) developed hematomas and 1 (0.36%) patient had excessive bleeding not requiring transfusion. None of these complications required removal of the device.
Conclusion:
Implementation of PVAS and use of ED-PIVs has demonstrated a reduction in CVC utilization, with low rates and severity of insertion-related complications. While further studies are required, this analysis provides promising results for the introduction of similar services in other institutions.
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