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© 2010 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 29:741-747 • 0278-4297

Comparison of Infection Rates Among Ultrasound-Guided Versus Traditionally Placed Peripheral Intravenous Lines

Srikar Adhikari, MD, RDMS, Michael Blaivas, MD, Daniel Morrison, MD, RDMS and Lina Lander, ScD

Departments of Emergency Medicine (S.A.) and Epidemiology (L.L.), University of Nebraska Medical Center, Omaha, Nebraska USA; Department of Emergency Medicine, Northside Hospital Forsyth, Cumming, Georgia USA (M.B.); and Department of Emergency Medicine, Wayne State University, Detroit, Michigan USA (D.M.).

Address correspondence to Michael Blaivas, MD, Department of Emergency Medicine, Northside Hospital Forsyth, 1200 Northside Forsyth Dr, Cumming, GA 30041-7659 USA. E-mail: mike{at}blaivas.org

Objective. The purpose of this study was to compare infection rates of peripheral intravenous (IV) lines placed under ultrasound guidance with traditionally placed IV lines. Methods. We conducted a retrospective review of emergency department (ED) and hospital records of adult patients who had a peripheral IV line placed in the ED and were admitted to the hospital over a 1-year period. This study took place at a level I academic urban ED with an annual census of 75,000. All admitted patients with a peripheral IV placed under ultrasound guidance in the ED were identified. Control patients had a traditional landmark approach. Emergency department nurses followed standard aseptic precautions when inserting both ultrasound-guided as well as traditionally placed IV lines. Researchers reviewed all parts of the medical record, including ED and inpatient notes. Descriptive statistics and {chi}2 and Fisher exact tests were used in data evaluation. Results. A total of 402 patients who had peripheral IV lines placed under ultrasound guidance were compared with 402 matched control patients. In the ultrasound-guided IV group, the mean time between insertion to catheter removal was 2.6 days compared with 2.4 days in the traditional group (P = .03). There were 2 documented infections in the ultrasound group and 3 in the traditional group, yielding infection rates of 5.2 per 1000 in the ultrasound-guided IV group and 7.8 per 1000 in the traditional approach group. There was no statistically significant difference between infection rates in the two groups (P = .68). Conclusions. Both traditional and ultrasound-guided approaches had low infection rates, suggesting that there is no increased risk of infection with ultrasound guidance for peripheral IV lines.

Key Words: emergency ultrasound • intravenous complications • intravenous infection • peripheral vascular access • ultrasound-guided vascular access • vascular ultrasound complications

Abbreviations: ED, emergency department • IV, intravenous

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