Ultrasonography-Guided Long Peripheral Catheters: Real-World Outcomes in Hospitalized Children

OBJECTIVE Despite being the most common vascular access devices in pediatric settings, short peripheral catheters (SPCs) frequently result in difficult insertion, limited dwell time, and multiple replacements. Ultrasonography-guided long peripheral catheters (LPCs) may improve catheter longevity, but evidence in pediatric wards remains limited, particularly for LPCs measuring 3 to 6.5 cm. We compared ultrasonography-guided LPCs with blind-inserted SPCs in this setting. PATIENTS AND METHODS We conducted a retrospective observational study. Patients aged 30 days to 18 years that were hospitalized for at least 5 days were included. Outcomes included catheter survival time, therapy completion with the first catheter, and complications per 1000 catheter-days. Statistical analyses included Kaplan-Meier survival curves, adjusted Cox regression, Poisson regression, and propensity score matching. RESULTS Among 250 patients, 41 received LPCs and 209 received SPCs. Median catheter survival was longer for LPCs (7.0 days; 95% CI, 5.0–9.0) than SPCs (3.0 days; 95% CI, 2.5–3.5; P < .0001). LPCs had lower risk of failure in adjusted Cox regression (hazard ratio, 0.51; 95% CI, 0.32–0.81; P = .004). Therapy completion with the first catheter occurred in 56.1% of patients with LPCs vs 17.2% of patients with SPCs (P < .0001). Complication rates were lower with LPCs (65.5 vs 193.6 per 1000 catheter-days; incidence rate ratio, 3.10; 95% CI, 1.98–4.85; P < .001). In multivariable analysis, LPCs were protective against early removal, whereas antibiotics and longer treatment duration increased failure risk. CONCLUSIONS Ultrasonography-guided LPCs showed longer dwell time, higher therapy completion rates, and fewer complications compared with blind-inserted SPCs. These findings support considering LPCs as first-line vascular access option in children requiring medium-term therapy, particularly those with difficult access or receiving antibiotics.