(660) Deciding the Type of Peripheral Vascular Access in the Pediatric Intensive Care Unit

Introduction: The current recommendations for vascular access in PICU, like the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) and the pediatric counterpart miniMAGIC, are based on the length of treatment, the osmolarity or vesicant properties of the infusion, and the need for hemodynamic monitoring. Due to the complications of central vascular access, some patients are managed exclusively by peripheral intravascular (PIVC) access and with extended dwell (EDC) or midline catheters (MC).

Methods: We enrolled patients aged 0-18 years admitted to PICU for over 24 hours and managed with peripheral access exclusively between January 1, 2019, and December 31, 2021 (record review).

Results: 404 patients (484) admissions fulfilled the criteria. Patients with peripheral access as exclusive mode had a lower pediatric risk of mortality (PRISM) mean scores and PICU length of stay, 18 (8.5) and 9.5 (6.4) days vs. 8.9 ( 5.9) and 5.7( 3.6) days, respectively. The PIVC mean operational time was 50.1 (65.3) hours and required a mean of 1.6(0.8) insertion attempts. Up to two PIVC insertions were sufficient for 44 % of the admissions, but 56% required three or more. Of the patients with three or more insertions, 37 % needed vascular consultation for EDC or MC, with an increased odds ratio of 5.2 (3.1-8.5) over the patients needing up to two insertions. Prolonged dwell time was associated with females, 24G catheter size, first attempt insertion, left-sided insertion, lack of edema, and less agitation. None of the prolonging factors could extend the time above 1.5 times the average PIVC dwell hours. Vancomycin and blood transfusion were associated with diminished time. There is a 42.8 % (460/1074) PIVC failure rate (reported as occluded or infiltrated) vs. 8.9% (11/123) for EDC or MC.

Conclusions: Peripheral vascular access management comes with different profiles and should not be decided as "no need for CVL." The PIVC's limited operational time can quickly lead to repeated attempts and insertions; some modifying variables prolong the duration but not sufficiently, and others decrease the operations time. Consideration for EDC or MC placement consultation might be helpful at the third PIVC insertion or in cases of edema or vancomycin infusion.