Underutilization of Large-Bore Intravenous Access and Outcomes in Unstable Gastrointestinal Bleeding

This retrospective cohort included adults (≥18 years) presenting with GI bleeding to 15 emergency departments within an integrated health system from January 2018 to July 2024. Patients transferred from outside facilities, lacking initial vital signs or documentation of IV access were excluded. LBIV access was defined as two ≥18-gauge peripheral IVs, central catheter >7.5 Fr or cordis. Hemodynamic instability was defined as systolic blood pressure

Emergency medicine guidelines recommend early large-bore intravenous (LBIV) access for hemodynamically unstable patients with gastrointestinal (GI) bleeding, yet adherence and associated outcomes remain unclear. The goal of this study was to evaluate LBIV use in unstable patients with GI bleeding and its association with mortality, transfusion outcomes, intensive care unit (ICU) utilization and hospital length of stay.

Among 24,052 patients, 1290 (5%) received LBIVs. A total of 4,067 (17%) patients were unstable but only 478 (12%) received LBIVs . In propensity matched unstable patients (n=956), mortality, transfusion rates, volume, and hospital length of stay were not statistically different, though ICU utilization remained higher (78% vs 59%, p

Large-bore intravenous access was underutilized among unstable patients with gastrointestinal bleeding. After matching for clinical severity and comorbidity, there were no differences in mortality or transfusion outcomes, although intensive care unit utilization was higher.