Daniel Z Adams1, Andrew Little2, Charles Vinsant1, Sorabh Khandelwal1. 1. Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio. 2. Department of Emergency Medicine, Doctors Hospital, Columbus, Ohio.
Abstract
BACKGROUND: Venous access in the emergency department (ED) is an often under-appreciated procedural skill given the frequency of its use. The patient's clinical status, ongoing need for laboratory investigation, and intravenous therapeutics guide the size, type, and placement of the catheter. The availability of trained personnel and dedicated teams using ultrasound-guided insertion techniques in technically difficult situations may also impact the selection. Appropriate device selection is warranted on initial patient contact to minimize risk and cost. OBJECTIVE: To compare venous access device indications and complications, highlighting the use of midline catheters as a potentially cost-effective and safe approach for venous access in the ED. DISCUSSION: Midline catheters (MC) offer a comparable rate of device-related bloodstream infection to standard peripheral intravenous catheters (PIV), but with a significantly lower rate than peripherally inserted central catheters (PICC) and central venous catheters (CVC) (PIV 0.2/1000, MC 0.5/1000, PICC 2.1-2.3/1000, CVC 2.4-2.7/1000 catheter days). The average dwell time of a MC is reported as 7.69-16.4 days, which far exceeds PIVs (2.9-4.1 days) and is comparable to PICCs (7.3-16.6 days). Cost of insertion of a MC has been cited as comparable to three PIVs, and their use has been associated with significant cost savings when placed to avoid prolonged central venous access with CVCs or in patients with difficult-to-access peripheral veins. Placement of a MC includes modified Seldinger and accelerated, or all-in-one, Seldinger techniques with or without ultrasound guidance, with a high rate of first-attempt success. CONCLUSION: The MC is a versatile venous access device with a low complication rate, long dwell time, and high rate of first-attempt placement. Its utilization in the ED in patients deemed to require prolonged hospitalization or to have difficult-to-access peripheral vasculature could reduce cost and risk to patients.
BACKGROUND:Venous access in the emergency department (ED) is an often under-appreciated procedural skill given the frequency of its use. The patient's clinical status, ongoing need for laboratory investigation, and intravenous therapeutics guide the size, type, and placement of the catheter. The availability of trained personnel and dedicated teams using ultrasound-guided insertion techniques in technically difficult situations may also impact the selection. Appropriate device selection is warranted on initial patient contact to minimize risk and cost. OBJECTIVE: To compare venous access device indications and complications, highlighting the use of midline catheters as a potentially cost-effective and safe approach for venous access in the ED. DISCUSSION: Midline catheters (MC) offer a comparable rate of device-related bloodstream infection to standard peripheral intravenous catheters (PIV), but with a significantly lower rate than peripherally inserted central catheters (PICC) and central venous catheters (CVC) (PIV 0.2/1000, MC 0.5/1000, PICC 2.1-2.3/1000, CVC 2.4-2.7/1000 catheter days). The average dwell time of a MC is reported as 7.69-16.4 days, which far exceeds PIVs (2.9-4.1 days) and is comparable to PICCs (7.3-16.6 days). Cost of insertion of a MC has been cited as comparable to three PIVs, and their use has been associated with significant cost savings when placed to avoid prolonged central venous access with CVCs or in patients with difficult-to-access peripheral veins. Placement of a MC includes modified Seldinger and accelerated, or all-in-one, Seldinger techniques with or without ultrasound guidance, with a high rate of first-attempt success. CONCLUSION: The MC is a versatile venous access device with a low complication rate, long dwell time, and high rate of first-attempt placement. Its utilization in the ED in patients deemed to require prolonged hospitalization or to have difficult-to-access peripheral vasculature could reduce cost and risk to patients.
Authors: David Paje; Anna Conlon; Scott Kaatz; Lakshmi Swaminathan; Tanya Boldenow; Steven J Bernstein; Scott A Flanders; Vineet Chopra Journal: J Hosp Med Date: 2018-02 Impact factor: 2.960
Authors: Silvia Manrique-Rodríguez; Irene Heras-Hidalgo; M Sagrario Pernia-López; Ana Herranz-Alonso; M Camino Del Río Pisabarro; M Belén Suárez-Mier; M Antonia Cubero-Pérez; Verónica Viera-Rodríguez; Noemí Cortés-Rey; Elizabeth Lafuente-Cabrero; M Carmen Martínez-Ortega; Esther Bermejo-López; Cristina Díez-Sáenz; Piedad López-Sánchez; M Luisa Gaspar-Carreño; Rubén Achau-Muñoz; Juan F Márquez-Peiró; Marta Valera-Rubio; Esther Domingo-Chiva; Irene Aquerreta-González; Ignacio Pellín Ariño; M Cruz Martín-Delgado; Manuel Herrera-Gutiérrez; Federico Gordo-Vidal; Pedro Rascado-Sedes; Emilio García-Prieto; Lucas J Fernández-Sánchez; Sara Fox-Carpentieri; Carlos Lamela-Piteira; Luis Guerra-Sánchez; Miguel Jiménez-Aguado; María Sanjurjo-Sáez Journal: Drugs R D Date: 2020-12-21