Background: A peripheral intravenous cannula (PIV) is used to administer IV fluids and medications. Early visual inspection and physical exam (VI/PE) of the PIV insertion site performed by registered nurse (RN) are essential to prevent or limit tissue damage caused by displaced PIV catheter. The most common PIV complication is peripheral intravenous extravasation/infiltration (PIVE/I). Skin ultrasound (US) of the PIV catheter site provides rapid, real-time, high-resolution images of the anatomic structures at the point-of-care (POC).
Objectives: To correlate the standard practice of clinical assessment (VI/PE) with POC-US exam to determine location and function of PIV catheters suspicious for malfunctioning.
Design/Methods: PIV sites suspicious for malfunctioning are assessed by RN and findings are recorded in electronic medical record. POC-US exam of the PIV site is performed immediately after VI/PE. Sonographic exam includes assessment of the skin for edema, PIVE/I fluid pockets, PIV catheter location assessed by Doppler flow during normal saline flush. RN's decision to continue or discontinue the PIV was based on VI/PE.
Results: Forty four infants were studied (Table 1). We found sufficient disagreement between the two methodologies (McNemar test, p=0.0074) with only fair agreement between the assessments (Gwet AC1 correlation coefficient is 0.34). In 29 (65.9%) cases there was concordance between VI/PE and POC-US, 18 to remove and 11 not to remove PIV. Discordance was noted in 15 (34.1%) cases. In 2 (4.5%) cases RN decided to leave in PIV, while POC-US was positive for PIVE/I. In 13 (29.5%) cases RN decided to take out PIV while POC-US was normal (Table 2). Results failed to provide enough evidence that swelling, as the most common initial clinical evaluation sign, is correlated to the US finding of tissue edema (p=0.67). On the other hand, flushing of PIV correlated well with the final US-based decision to remove PIV (p<0.0001).
Conclusion: There is only a fair correlation between VI/PE of the suspicious PIV site and POC-US exam of the same site. However, our data suggest that in the evaluation of questionable PIVs POC-US could be used with VI/PE. This combination may improve the accuracy of decisions to remove or maintain PIV catheters, which will result in decreased number of PIV catheter placement attempts and complications.
