Ultrasound-Guided Peripheral Intravenous Placement Practices: A National Survey of Gel Use

Point-of-care ultrasound (POCUS) is used to place ultrasounded-guided peripheral intravenous catheters (US-PIV) in patients with difficult vascular access. In May 2025, the Department of Public Health (DPH) and the Centers for Disease Control and Prevention (CDC) issued a national warning regarding growth of Paraburkholderia fungorum in non-sterile ultrasound gel products and recommended sterile ultrasound gel for all percutaneous procedures. The primary study aim was to determine the percentage of emergency departments (EDs) making changes to their US-PIV gel or policies in response to this recommendation.

This was a cross-sectional, national survey of ultrasound guided PIV use in EDs taking place between 8/14/2025 and 9/31/2025. Inclusion criteria was survey response, with duplicate responses excluded. A 15-question survey was sent to the ACEP ultrasound section (1,650 members), the Society of Academic Emergency Medicine (SAEM) Academy of Emergency Ultrasound (AEUS) (559 members), and the Society of Clinical Ultrasound Fellowships (SCUF) (700 members), with two reminder emails.

The survey received 175 responses, with 143 unique institutional responses, used for statistical analysis. An ED policy for US-PIV was reported at 107 institutions (74.8%), whereas 29 (20.3%) reported no policy, and 7 (4.9%) respondents did not know whether such a policy existed. After the CDC notice, no change in ED US-PIV policy was made at 94 (87.9%) of the responding institutions, however, 68 (72.3%) of the 94 institutions reporting no changes already recommended sterile gel for US-PIV in the policy. Of the 34 (23.8%) institutions who reported making changes, 31 changed gel to a sterile product for US-PIV, 3 changed their ED US-PIV policy. A total of 11 sites reported unknown changes, with 6 of those sites having an ED US-PIV policy and 6 using sterile gel for US-PIV. Four sites reported no changes but an emphasis on using sterile gel for US-PIV. Common themes from narrative comments included a shift towards sterile gel, inconsistent adherence to existing guidelines, and practical barriers to change.

Our survey determined that among the 143 institutions, approximately 75% had an ED policy for US-PIV. The CDC notice resulted in one in five institutions making changes to their gel, with anecdotal reports of varying compliance by staff. The survey results suggest room for continued improvement.