Comparison of procedural duration among ultrasound-guided IVs,mini-midline catheters,and central venous catheters inserted in the emergency department

Abstract

Background:

Patients with difficult intravenous (IV) access in emergency departments (EDs) often require invasive vascular access techniques, including ultrasound-guided peripheral intravenous catheters (USGIVs), mini-midline catheters (MMCs), and central venous catheters (CVCs). Although prior research has explored the safety and survival time of these vascular access devices (VADs), there is little available literature in comparing their procedural duration and clinical utility.

Methods:

A prospective observational study was conducted to evaluate the procedural duration, catheter utilization, and survival time of USGIV, MMC, and CVC insertion in the ED of a Level 1 Trauma Center. Procedural duration was measured using direct time-motion observations. Catheter utilization was assessed through prospective chart reviews. Statistical comparisons were performed using primarily the Wilcoxon Rank Sum Test and descriptive statistics.

Results:

A total of 51 successful VAD insertions were observed: 13 USGIVs, 18 MMCs, and 20 CVCs. The mean total procedural duration (minutes) of CVCs was significantly longer than both USGIVs (p < 0.001, 95% Confidence Interval (CI) of the difference 15.45–26.94) and MMCs (p < 0.001, 95% CI of the difference 8.13–21.85), while no significant difference was found between MMCs and USGIVs (p = 0.085, 95% CI of the difference −0.38 to 12.90). Median catheter survival with early outliers removed was 2.5 days for USGIVs, 4.9 days for MMCs, and 5.2 days for CVCs. The mean number of IV medications infused within 24 h was 1.3 (Standard Deviation (SD) 1.5) for USGIVs, 5.3 (SD 3.7) for MMCs, and 7.3 (SD 3.2) for CVCs. The mean number of blood draws within 24 h was 3.8 (SD 2.3) for USGIVs, 5.8 (SD 3.2) for MMCs, and 7.2 (SD 2.3) for CVCs.

Conclusions:

These findings suggest that MMCs required less time to place than CVCs in the ED setting while also demonstrating expanded clinical functionality and longevity compared to USGIVs.