Dwell Time of Ultrasound-Guided Peripheral IV Catheters Placed in the Emergency Department

Methods: This retrospective, single-center study evaluated 498 US-PIVs placed in adult emergency department patients. Dwell time was defined as the interval between documented placement and removal. Descriptive statistics were used to summarize dwell time distribution. Logistic regression analyses assessed factors associated with early failure and prolonged survival, defined as duration beyond the 75th percentile (82.25 hours).

Background: Ultrasound-guided peripheral intravenous catheters (US-PIVs) are commonly used in emergency departments for patients with difficult vascular access. Despite increasing utilization, data regarding their dwell time and predictors of failure or prolonged function remains limited. Guidelines recommend that PIV catheters be replaced after 48-72 hours as prolonged dwell time has been associated with adverse effects. Objectives: To characterize the dwell time of US-PIVs placed in the emergency department and identify patient and clinical factors associated with prolonged catheter survival.

Results: The mean dwell time in this study was 57.4 hours, with a median time of 28.3 hours. 25% of catheters exceeded 82.25 hours, and 10% remained in place for more than 151 hours. Advanced age (≥65 years), higher acuity (lower ESI), and comorbidities such as diabetes, congestive heart failure (CHF), end-stage renal disease (ESRD), and a history of intravenous drug use (IVDU) were significantly associated with prolonged catheter survival. Early failure was more likely in patients with shallow vessel depth, hypotension (SBP < 90 mmHg), and catheters placed by resident physicians.

Conclusion: US-PIVs frequently remain functional well beyond traditional dwell time recommendations, with minimal evidence of increased complication risk. Select patient populations, especially those with chronic illnesses or high acuity may benefit from longer-term use of US-PIVs. These findings support a clinically indicated removal strategy rather than routine time-based replacement.