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Long Peripheral Catheters for Intravenous Access in Adults And

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Long Peripheral Catheters for Intravenous Access in Adults And The Journal of JVA Vascular Access Review The Journal of Vascular Access 1–11 Long peripheral catheters for ª The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions intravenous access in adults and DOI: 10.1177/1129729820927272 children: A systematic review of journals.sagepub.com/home/jva the literature Kirby R Qin1,2 , Nicholas Ensor1,2, Richard Barnes3 , Anna Englin3, Ramesh M Nataraja1,2,4 and Maurizio Pacilli1,2,4 Abstract Background: Long peripheral catheters are peripheral intravenous catheters of 6–15 cm in length. They are commonly inserted into the forearm, antecubital fossa or upper arm using a direct Seldinger technique. They have proven to be valuable for peripheral intravenous catheters, particularly in patients with difficult intravenous access. Methods: We conducted a systematic review of studies reporting the use of long peripheral catheters. The following keywords were used: ‘long’, ‘Seldinger’, ‘guidewire’, ‘peripheral’, ‘venous’, ‘intravenous’, ‘IV’, ‘vascular’, ‘cannula’ and ‘catheter’. Results: Three hundred forty-one publications were identified; 16 were included in the systematic review. There were 11 adult studies and 5 paediatric studies documenting 1288 long peripheral catheters in 1271 patients. Majority of studies (12/ 16) were conducted in acute care settings, (emergency department, n ¼ 6; intensive care unit, n ¼ 3; high dependency unit, n ¼ 1; surgical unit, n ¼ 2). The most frequently studied long peripheral catheter was 8 cm in length and 20 G in size. Nine studies recruited patients with difficult intravenous access; 11 studies used ultrasound guidance. Insertion success rate and mean procedural time ranged between 86% and 100% and 8 and 16.8 minutes, respectively. Average catheter duration ranged between 4 and 14.7 days (mean) and 1.1 and 9 days (median). Catheter failure occurred in 4.3–52.5% of long peripheral catheters, with leakage, infiltration and dislodgement being the most frequent causes of failure. In 3 randomised controlled trials, long peripheral catheters outperformed peripheral intravenous catheters in terms of duration and failure rate. Conclusion: Long peripheral catheters are safe and reliable in both adults and children. In addition, long peripheral catheters may provide improved quality of care over peripheral intravenous catheters for multi-day intravenous therapy. Keywords New devices, peripheral venous access, long peripheral catheter, direct Seldinger technique, cannula Date received: 1 November 2019; accepted: 25 April 2020 1 Department of Paediatric Surgery, Monash Children’s Hospital, Melbourne, VIC, Australia Introduction 2 Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Venous access devices (VADs) that terminate in or distal to Melbourne, VIC, Australia the subclavian and femoral veins are termed peripheral 3 Department of Anaesthesia, Monash Children’s Hospital, Melbourne, venous catheters. Peripheral venous catheters can be VIC, Australia 4 Department of Surgery, School of Clinical Sciences at Monash Health, divided into peripheral intravenous catheters (PIVCs), long Faculty of Medicine, Nursing and Health Sciences, Monash University, peripheral catheters (LPCs) and midline catheters Melbourne, VIC, Australia (MCs).1,2 PIVCs (commonly referred to as ‘cannulae’ or ‘cannu- Corresponding author: las’) are the most common VADs. They are 3–6 cm in Maurizio Pacilli, Department of Paediatric Surgery, Monash Children’s Hospital, Level 5, 246 Clayton Road, Clayton, Melbourne, VIC 3168, length and are inserted using a catheter-over-needle tech- Australia. nique. LPCs are peripheral dwelling catheters of 6–15 cm Email: [email protected] 2 The Journal of Vascular Access in length and are commonly inserted using a direct Seldin- Results ger technique, the catheter-over-guidewire method origi- A total of 341 titles and abstracts were screened. Of these, nally described for arterial catheterization.2,3 They are 27 articles met the initial inclusion criteria. Following inserted into the forearm, antecubital fossa or upper arm assessment of full-text documents, 11 articles were and terminate before reaching the axilla, generally no fur- excluded: six studies6–11 used guidewire-inserted PIVCs, ther than the mid-upper arm. MCs are 15–25 cm long and two studies12,13 used standard PIVCs, one study14 did not inserted at or above the antecubital fossa, with distal exten- report the number of LPCs used and one study15 did not sion past the axilla. Insertion is achieved with a modified report the number of patients investigated. A final study16 Seldinger technique, which involves the initial introduction was excluded as the authors primarily described LPCs of a tissue dilator to accommodate for the longer and larger placed in the internal jugular vein (95.1%) – a decision MC.4 was made to exclude this article as the results would be In recent years, LPCs have grown in popularity because difficult to compare with LPCs placed in limb veins. Over- of their clinical utility, particularly in patients with difficult all, 16 studies were included in the final analysis (Figure intravenous access (DIVA). Many patients presenting to 1). the emergency department (ED) will require admission and extended intravenous (IV) therapy. LPCs could reduce the number of catheters required in patients receiving 7–28 days of IV therapy and decrease the incidence of Main findings catheter-related complications.5 The aim of this article is The characteristics of included studies are summarised in to provide a comprehensive summary of the experience of Table 1. Sixteen studies reporting 1288 LPCs in 1271 LPCs across various institutions, based on the results of a patients are included in this review. All studies were pub- systematic review. lished between 2005–2019. These included 13 prospective (four RCTs17–20 and nine cohort studies5,21–28) and three retrospective reviews.15,29–31 Three RCTs17–19 compared 20 Methods LPCs and PIVCs; one compared LPCs and peripherally inserted central catheters (PICCs). Eleven adult stud- This review was prospectively registered with the PROS- ies15,17–23,25,26,30 reported 647 patients, and five paediatric PERO (International Prospective Register of Systematic studies5,24,27,29,31 documented 624 patients. Studies were Reviews) database (ID: CRD42018090335). conducted in EDs17,19,23,27,28,30 (n ¼ 6), medical units24–26 A literature search of PubMed, Scopus, MEDLINE, (n ¼ 3), surgical units5,21 (n ¼ 2), intensive care Web of Science and the Cochrane Library was performed units22,29,31 (ICU) (n ¼ 3), a high-dependency unit18 in September 2019. The following keywords were used: (n ¼ 1) and in patients receiving IV vancomycin15 (n ¼ 1). ‘long’, ‘Seldinger’, ‘guidewire’, ‘peripheral’, ‘venous’, Table 2 displays catheter insertion details. In nine stud- ‘intravenous’, ‘IV’, ‘vascular’, ‘cannula’ and ‘catheter’. ies,18,19,21–23,25,27,28,30 DIVA status was an inclusion criter- The search was limited to human studies with abstracts ion. DIVA was defined by multiple criteria including written in English and published since 1980. failure of multiple PIVC insertion attempts, lack of visible Inclusion criteria included any primary research arti- or palpable veins and history suggesting DIVA. All LPCs cles (i.e. randomised controlled trials (RCTs) and cohort were placed under ultrasound guidance (USG) per study studies) that described a peripheral-dwelling venous protocol in 11 cases,17–23,25,27,28,30 while in the remainder, catheter of 6–15 cm in length inserted using the direct the decision to use USG was practitioner dependent (Table Seldinger method. Studies of both adult and paediatric 2). DIVA status and USG were both common features patient populations were considered for inclusion in this among adult studies; 10 of 11 studies investigated patients review. Case reports, editorials and abstract-only articles with DIVA and used USG for all catheters. were excluded. Twelve studies reported the successful insertion rate Two authors (K.Q. and N.E.) performed independent ranging from 86%–100%, with five reporting literature searches. Full texts for all potential studies were 100%.21,22,24,27,30 The cumulative success rates were reviewed and critically appraised according to predeter- 95.3% (1124/1179) in all patients, 96.2% (477/496) in mined inclusion and exclusion criteria. References of all adult patients and 91.5% (647/683) in children. Catheter included articles were reviewed to ensure all relevant arti- dimensions ranged from 6–15 cm in length and 16–23G in cles were included. Any disagreement over the eligibility diameter (Table 2). The most common length and diameter of studies was resolved through discussion with a third were 8 cm and 20G, respectively. Seven brands of VADs author (M.P.). Two authors (K.Q. and N.E.) independently were reported in 12 studies; of these, eight studies used extracted relevant data from all included studies. Data catheters marketed as LPCs,5,19,20,24–26,30,31 while the extracted from included studies was evaluated by a third remaining used arterial catheters21,22,28 and central venous author (M.P.). catheters (CVCs).18,23 All studies, except one, used direct Qin et al. 3 Figure 1. PRISMA flowchart showing the systematic review process. PIVC: peripheral intravenous catheter; VAD: venous access device; CVC: central venous catheter; LPC: long peripheral catheter. Seldinger (catheter-over-guidewire) devices. The single complications,
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