Some studies show increased extravasation risk of ultrasound guided peripheral intravenous catheters (USGIVs). This is a commonly encountered clinical scenario. It would be nice to know if this is a risk related to the ultrasounds being placed by ultrasound or something else. This study aims to look at that question.
Do IVs placed by US have more risk of extravasation during IV contrast administration compared to IVs placed under standard methods?
Single center, academic ED
Adults ≥18 who underwent CT with IV contrast
Two groups: Ultrasound guided IV or regular IV
Emergency physicians at academic center
Retrospective chart review
Outcome was extravasation of IV contrast during CT scan
Took all patients getting CT with IV contrast and then determined which type of IV (US guided vs standard).
Multivariable logistic regression including age, sex, history of intravenous drug abuse, chemotherapy, vascular disease (including diabetes, hypertension, end-stage renal disease, peripheral vascular disease), BMI, history of admission in past year
For the regression, they used all USGIV + all standard IV with extravasation + 2% random sample of standard IV and no extravasation
Retrospectively determined if there was ultrasound guided IV placement or standard IV placement
Both 1.75 inch and 2.5 inch catheters were used
Peripheral IV placement under ultrasound guidance
40,143 patients underwent CT with contrast over 64 months
364 had Ultasound Guided IV (USGIV) Compared to 39,779 patients with standard IV
Patients in USGIV group were older, IVDA, chemo, PVD and hospitalizations more
115 total extravasations
3.6% (13/364) with USGIV
0.3% (102/39,779) with standard IV
Absolute risk difference 3.3%
USGIV associated with extravasation - adjusted Odds ratio (aOR) = 8.6
Females (aOR 1.8), hospitalization in last year (aOR 2.0), and IV drug abuse (aOR 5.8) associated with extravasation
One extravasation lead to unexpected admission in regular IV group
Similar proportions of plastic surgery consultation 23 in USGIV and 32.4% in standard IV
Dedicated US training program
Could not differentiate 1.75 inch vs 2.5 inch catheters
Two stage model - they needed to have a random sample selected in order to be representative of the standard IV group.
Did not take into account location of IV catheters, number of attempts, other confounding factors
1. Ultrasound guided peripheral IVs are more likely to extravasate during CT - absolute risk difference 3.3%.
2. Other factors in the patients who often require these IVs also predisposes them to extravasation.
3. In this study, the extravasations did not lead to significant difference in patient centered outcomes such as interventions.