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Original Research

Program: Section on Critical Care

P2A358: Peripheral Vascular Access as Exclusive Access Mode in Pediatric Intensive Care Unit (PICU)

Saturday, October 21, 2023
11:15 AM – 12:15 PM US EDT
Location: Walter E. Washington Convention Center, Exhibit Hall A
Poster Presentation
Background: The current recommendations for vascular access are based on the length of treatment, the osmolarity or vesicant properties of the infusion, and the need for hemodynamic monitoring. Due to the complications of central vascular access, some patients are managed in the PICU environment exclusively by peripheral intravascular (PIV) access and with extended dwell (ED) or Midline Catheters (MC). This study examines the factors influencing the dwell time of PIVs and the need for ED or MC placement.

Methods: Retrospective cohort analysis in a tertiary academic PICU. We enrolled patients aged 0-18 years admitted to PICU for over 24 hours and managed with peripheral access exclusively between January 1, 2019, and December 31, 2021.

Results: There were 404 patients (484) admissions. Overall, patients with peripheral access as exclusive mode had a lower pediatric risk of mortality (PRISM) mean scores and PICU length of stay, 18 (SD 8.5) and 9.5 days (SD 6.4) vs. 8.9 (SD 5.9) and 5.7 days (SD 3.6), respectively. The PIV mean dwell time was 50.1 hours (SD 65.3) and required a mean of 1.6 insertion attempts (SD 0.8). Up to two PIV insertions were sufficient for 44 % of the admissions, but 56% required three or more. Of the patients with three or more insertions, 37 % needed vascular consultation for ED or MC, with an increased odds ratio of 5.2 (3.1-8.5) over the patients needing up to two insertions. Prolonged dwell time was associated with females, 24G catheter size, first attempt insertion, left-sided insertion, lack of edema, and less agitation. Still, no prolonging factors could extend the time above 1.5 times the average PIV dwell hours. Vancomycin and blood transfusion were associated with diminished time.

Conclusion: The PIV limited dwell time can quickly lead to repeated attempts and insertions, and the modifying factors cannot prolong it sufficiently. Consideration for ED or MC placement consultation might be helpful after the third PIV insertion.