Outcomes of Using a Modified Seldinger Technique for Long Term Intravenous Therapy in Hospitalized Patients with Difficult Venous Access

Background and SignificanceMany hospitalized patients require an intravenous (IV) catheter to maintain vascular access or for administration of fluids and medications. The best approach to attaining peripheral intravenous (PIV) access for long term therapy is unknown, particularly in patients with a history of difficult IV placement.PurposeTo measure clinical outcomes using a Modified Seldinger Technique (MST) with ultrasound (US) guidance to achieve and maintain PIV for long term IV therapy.MethodsSubjects were patients with a history of difficult peripheral intravenous catheter placement and need for IV therapy longer than 72 hours. Modified Seldinger Technique was used with US guidance to place all PIVs in the deep veins of the upper extremities.ResultsA convenience sample of 157 subjects was enrolled in the study. Mean dwell time for catheter duration was seven days. First attempt placement success was 95%, 88.5% of patients had completion of IV therapy, and a low overall complication rate (9.57/1000 catheter days).ConclusionUsing MST for access for long term PIV therapy was associated with low complications and effective in our study population. Using MST requires specialized knowledge and skills, including the use of US and specialized insertion techniques. In patients who require extended PIV therapy with a history of difficult IV placement, this type of insertion technique may have benefit.