Peripheral venous catheters can be divided into three groups:
- peripheral intravenous catheters (PIVCs);
- long peripheral catheters (LPCs);
- midline catheters (MCs).
Each of them has specific characteristics:
Peripheral intravenous catheters (cannulas)
PIVCs vary between 3 and 6 cm in length and are commonly placed in the veins of the upper limb, distally to the antecubital fossa, and terminate well before the axilla.
Long peripheral catheters
LPCs are 6–15 cm catheters inserted in the forearm or upper arm. The distal tip terminates before reaching the axilla, typically no further than the mid-upper arm.
Midline catheters
MCs are 15–25 cm in length and are inserted into peripheral veins in the forearm or upper arm. The distal tip terminates into the axillary vein (mid-clavicular region).
Background
Intravenous (IV) therapy is one of the most common interventions administered to hospitalized patients. PIVCs, also known as ‘cannulas’, are the standard devices used to deliver IV therapy and are essential for the provision of fluids, basic medications and blood products. However, there is increasing recognition that PIVCs are unreliable after 2-3 days of usage and associated with several complications (Table 1).
Many conditions require multi-day IV therapy; therefore, it is common for a patient to receive multiple PIVCs during a single admission.
Achieving IV access can be a challenging task for both clinicians and patients. Venepuncture in children can be traumatic, especially when the procedure is unsuccessful and multiple attempts are necessary. In addition, the requirement for IV device reinsertions can delay the delivery of crucial IV therapy. LPCs could potentially be more durable than PIVCs, and thereby improve the quality of care in adults and children.
Table 1. Incidence of PIVCs complications in adults and children
Current studies comparing PIVCs versus LPCs
Figure 1. Current published articles comparing PIVCs versus LPCs; RCT = randomized controlled trial.
Overall LPCs performance including adults and children:
- Catheter duration (mean/median time): 1.1 – 14.7 days
- Failure rate (percentage): 2.0 – 52.5% (most common causes: infiltration, phlebitis, dislodgement, occlusion)
Results of three RCTs in adults
Figure 2. Current randomized controlled trials comparing PIVCs versus LPCs
Results from one RCT in children (Qin Kr et al., 2021)
Figure 3: Comparison of failure rate
Catheter survival
Figure 4: Kaplan-Meier curve showing the percentage survival of LPCs and PIVCs over time. Note that after 48 hours of use the survival of PIVCs is dramatically reduced while LPCs still provide reliable venous access.
Completion of therapy with one catheter
Figure 5. Percentage of children completing the treatment with one catheter only.
Cause of failure
Figure 6. Causes of failure. Infiltration was most common amongst PIVCs (12/24). Occlusion was most common amongst LPCs (4/7).
Conclusions
LPCs are safe and reliable peripheral vascular devices in adults and children. In addition, LPCs may represent an improvement to the quality of care, as demonstrated by three RCTs in adults and one randomized controlled trial in children where they outperformed PIVCs.
The results of these RCTs demonstrate that LPCs should be considered the catheter of choice in all patients requiring multi-day intravenous therapy. LPCs have lower failure rates, reduce total number of catheters and will likely improve patient satisfaction.
References
– Long peripheral catheters: Is it time to address the confusion? Qin KR, Nataraja RM, Pacilli M. J Vasc Access. 2019;20(5):457-460.
– Incidence of peripheral intravenous catheter failure and complications in paediatric patients: Systematic review and meta analysis. Indarwati F, Mathew S, Munday J, Keogh S. Int J Nurs Stud. 2020 Feb;102:103488.
– Peripheral intravenous catheter non-infectious complications in adults: A systematic review and meta-analysis. Marsh N, Webster J, Ullman AJ, Mihala G, Cooke M, Chopra V, Rickard CM. J Adv Nurs. 2020 Dec;76(12):3346-3362.
– Prevalence and source of pain in pediatric inpatients. Cummings EA, Reid GJ, Finley GA, McGrath PJ, Ritchie JA. Pain. 1996;68(1):25-31.
– Standard versus long peripheral catheters for multiday iv therapy: A randomized controlled trial. Qin KR, Ensor N, Barnes R, Englin A, Nataraja RM, Pacilli M. Pediatrics. 2021 Jan 14:e2020000877. doi: 10.1542/peds.2020-000877. Online ahead of print. PMID: 33446506.
– Long peripheral catheters and midline catheters: Insights from a survey of vascular access specialists. Qin KR, Pittiruti M, Nataraja RM, Pacilli M. J Vasc Access. 2020 Oct 20:1129729820966226. doi: 10.1177/1129729820966226. Online ahead of print. PMID: 33078685
– Long peripheral catheters for intravenous access in adults and children: A systematic review of the literature. Qin KR, Ensor N, Barnes R, Englin A, Nataraja RM, Pacilli M. J Vasc Access. 2020 Jun 12:1129729820927272. doi: 10.1177/1129729820927272. Online ahead of print. PMID: 32529915.
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