Ultrasonography-Guided Long Peripheral Catheters: Real-World Outcomes in Hospitalized Children

Abstract

OBJECTIVE: Despite being the most common vascular access devices in pediatric settings, short peripheral catheters (SPCs) frequently result in difficult insertion, limited dwell time, and multiple replacements. Ultrasonography-guided long peripheral catheters (LPCs) may improve catheter longevity, but evidence in pediatric wards remains limited, particularly for LPCs measuring 3 to 6.5 cm. We compared ultrasonography-guided LPCs with blind-inserted SPCs in this setting. PATIENTS AND METHODS: We conducted a retrospective observational study. Patients aged 30 days to 18 years that were hospitalized for at least 5 days were included. Outcomes included catheter survival time, therapy completion with the first catheter, and complications per 1000 catheter-days. Statistical analyses included Kaplan-Meier survival curves, adjusted Cox regression, Poisson regression, and propensity score matching. RESULTS: Among 250 patients, 41 received LPCs and 209 received SPCs. Median catheter survival was longer for LPCs (7.0 days; 95% CI, 5.0-9.0) than SPCs (3.0 days; 95% CI, 2.5-3.5; P < .0001). LPCs had lower risk of failure in adjusted Cox regression (hazard ratio, 0.51; 95% CI, 0.32-0.81; P = .004). Therapy completion with the first catheter occurred in 56.1% of patients with LPCs vs 17.2% of patients with SPCs (P < .0001). Complication rates were lower with LPCs (65.5 vs 193.6 per 1000 catheter-days; incidence rate ratio, 3.10; 95% CI, 1.98-4.85; P < .001). In multivariable analysis, LPCs were protective against early removal, whereas antibiotics and longer treatment duration increased failure risk. CONCLUSIONS: Ultrasonography-guided LPCs showed longer dwell time, higher therapy completion rates, and fewer complications compared with blind-inserted SPCs. These findings support considering LPCs as first-line vascular access option in children requiring medium-term therapy, particularly those with difficult access or receiving antibiotics.