Background: Obtaining peripheral vascular access can be challenging in the acutely ill or injured patient for a variety of reasons. Ultrasound-guided peripheral intravenous (PIV) access has been shown to be an effective method of obtaining access in these challenging patients. However, this technique is relatively new and the long-term effect on venous integrity of the target vessels is unknown. The American Society of Nephrology recommends to avoid placement of peripherally inserted central catheter (PICC) lines or proximal upper extremity venous catheters in chronic kidney disease (CKD) patients (including patients on dialysis as well as patients being planned for dialysis) unless absolutely necessary due to its Fistula First Initiative and the need for preservation of future venous targets. The target vessels used in ultrasound-guided PIVs are frequently the same ones used for PICC lines. To date, no studies have been done that evaluate the restrictions placed on ultrasound-guided PIVs in CKD patients in the Emergency Department.
Methods: We surveyed 110 ultrasound fellowship programs listed on eusfellowships.com and had a total of 56 programs respond (51%). Data were collected on a voluntary basis and statistical analysis of the results are reported by frequency with interquartile ranges.
Results: Of the programs that responded, 1 program (2%) reported having restrictions on placing PIVs in CKD stage 3 or greater patients. Routine placement of PIVs in CKD stage 3 or greater patients was reported in 49 of 51 programs (96%). Furthermore, 53 of 56 programs (95%) did not restrict vessels that could be targeted for PIVs. The placement of greater than 2,000 PIVs annually on patients regardless of CKD status was reported in 15 of 56 programs (27%).
Conclusion: The vast majority of ultrasound fellowship programs do not have restrictions on placing PIVs in CKD patients. The long term effects of ultrasound-guided PIVs on venous integrity and subsequent fistula creation is unknown. When placing these ultrasound-guided PIVs, venous targets in the distal forearm and hand should be sought first.