Superior Venous Access, Midline vs Ultrasound IVs
| Status: | Enrolling by invitation |
|---|---|
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 5/3/2018 |
| Start Date: | April 23, 2018 |
| End Date: | June 2019 |
Superior Venous Access, Midline vs Ultrasound IVs: A Randomized Clinical Trial
Obtaining intravenous access (IVA) is the most common procedure performed in the emergency
department (ED). Placement of IVA allows for blood work and delivery of intravenous fluids
and medications. The implementation of ultrasound guided peripheral IVs (UGPIV) have allowed
for ultrasound to be used to place an IV into patients with difficult vein access (DVA). An
alternative device to place is a midline catheter (MC). The use of MCs against UGPIV has not
been compared in a randomized study. Aim 1: To determine if UGPIVs have a higher failure rate
than midline catheters within 72 hours of placement. Aim 2: To collect information to perform
a direct cost analysis of UGPIV against that of the midline catheter. Aim 3: Assess patient
satisfaction.
department (ED). Placement of IVA allows for blood work and delivery of intravenous fluids
and medications. The implementation of ultrasound guided peripheral IVs (UGPIV) have allowed
for ultrasound to be used to place an IV into patients with difficult vein access (DVA). An
alternative device to place is a midline catheter (MC). The use of MCs against UGPIV has not
been compared in a randomized study. Aim 1: To determine if UGPIVs have a higher failure rate
than midline catheters within 72 hours of placement. Aim 2: To collect information to perform
a direct cost analysis of UGPIV against that of the midline catheter. Aim 3: Assess patient
satisfaction.
This is a randomized controlled trial to determine if the midline catheter is superior to the
ultrasound guided IV with respect to survival at 72 hours.
Aim 1: To determine if UGPIVs have a higher failure rate than midline catheters within 72
hours of placement. There are several reasons why UGPIVs may fail. UGPIVs are shorter than
midline catheters, and shorter catheters may fail due to infiltration which can be a result
of malposition as well as having the catheter pull out of the vessel. It is being
hypothesized that by using a midline catheter with a guidewire for placement with additional
catheter length placed into the vessel, midlines will be superior to UGP\Vs with regards to
survival time of the catheter. The investigators will assess catheter survival daily until 72
hours (when UGPIV are recommended to be changed). The total lifetime of the midline catheters
will be recorded.
Aim 2: To perform a direct cost analysis of UGPIV against that of the midline catheter. This
study will not be large enough to complete a robust cost effectiveness analysis to compare
UGPIV to mid line catheters. As a part of this study the investigators will collect
information including but not limited to: the number of catheters used for IVA attempts, time
for placement of each device complications, and need for additional IVA during
hospitalization.
Aim 3: For patients that remain hospitalized at 72 hours a satisfaction survey will be
administered to determine patient experience and preference for the type of vascular access
that they receive.
ultrasound guided IV with respect to survival at 72 hours.
Aim 1: To determine if UGPIVs have a higher failure rate than midline catheters within 72
hours of placement. There are several reasons why UGPIVs may fail. UGPIVs are shorter than
midline catheters, and shorter catheters may fail due to infiltration which can be a result
of malposition as well as having the catheter pull out of the vessel. It is being
hypothesized that by using a midline catheter with a guidewire for placement with additional
catheter length placed into the vessel, midlines will be superior to UGP\Vs with regards to
survival time of the catheter. The investigators will assess catheter survival daily until 72
hours (when UGPIV are recommended to be changed). The total lifetime of the midline catheters
will be recorded.
Aim 2: To perform a direct cost analysis of UGPIV against that of the midline catheter. This
study will not be large enough to complete a robust cost effectiveness analysis to compare
UGPIV to mid line catheters. As a part of this study the investigators will collect
information including but not limited to: the number of catheters used for IVA attempts, time
for placement of each device complications, and need for additional IVA during
hospitalization.
Aim 3: For patients that remain hospitalized at 72 hours a satisfaction survey will be
administered to determine patient experience and preference for the type of vascular access
that they receive.
Inclusion Criteria:
- Patient at least 18 years of age being treated in the emergency department at Boston
Medical Center
- Standard IVA cannot be obtained by two qualified ER staff
- Have an upper extremity (left or right arm) that can accept a deep venous IV
- Clinical team believes the patient is likely to require inpatient admission at time of
needing IV access
- English speaking
- Able to provide consent
Exclusion Criteria:
- Patient expected to be discharged from the emergency department or discharged from the
hospital within 1 nights stay.
- Prisoner
- Pregnancy
- Requires central line or midline catheter as an expected requirement of care
- Patients who are expected to require medication that is not approved for
administration via a peripherally guided IV or midline as defined by hospital pharmacy
guidelines.
- Patients known to have bacteremia or have a high suspicion of bacteremia
- The patient is known or is suspected to be allergic to materials contained in the
device
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