Q&A UG PIV – What size qualifies as short?

Q. I was just inquiring regarding your Ultrasound Guided Peripheral Catheter Insertion class. The class descriptions says it will teach Placement of a Short Peripheral IV Catheter using Ultrasound Guidance, but what size qualifies as short. I work in pediatrics and PICU, our smallest gauge IVs are 24G 0.75in (19mm). Does this class accommodate this size? If not what is the smallest size? CM 10/4/20

A. Ultrasound Guided Peripheral Catheter Insertions (UGPIV) require longer catheters, not necessarily larger gauge sizes. The longer catheters are needed since the depth of insertion tends to be greater. The smallest gauge size for UGPIV right now is a 24g 1.25” (BBraun) and could be used for vein depth less than 0.5cm and would work with pediatric patients. Again, length is the most important issue, so a 24g 0.75” catheter will not work well if the depth of insertion is greater than 0.2cm. You want at least half of the catheter to remain inside the vein. According to the Bahl research the minimal amount of catheter you should have within the vein is 2-2.75cm (1cm=2.54”), but this research is based on adults. In simple form, at least an inch of catheter should enter into the vein after reaching the vein. The chart I have attached shows you how much catheter length is needed based on depth and angle of insertion. Common length for UGPIV insertion is 1.75” or greater for depths between 0.25-1.25cm.

Neonatal and pediatric clinicians are beginning to embrace ultrasound for peripheral catheter insertions more and more. Ultrasound provides a means to located, measure vein size, and depth to determine the best catheter selection customized for the patient.

PICC Excellence is here to help you increase your knowledge of ultrasound to help you with your patients!

Nancy Moureau PhD, RN, CRNI, CPUI, VA-BC and CEO PICC Excellence Inc. Hartwell GA 30643

Vein to Catheter Ratio Chart with Depth 2020

https://www.researchgate.net/publication/338638482_Ultralong_Versus_Standard_Long_Peripheral_Intravenous_Catheters_A_Randomized_Controlled_Trial_of_Ultrasonographically_Guided_Catheter_Survival

https://www.sciencedirect.com/science/article/abs/pii/S1552885518300230Longevity and Complication Rates of Ultrasound Guided Versus Traditional Peripheral Intravenous Catheters in a Pediatric Emergency Department – ScienceDirect

https://pediatrics.aappublications.org/content/145/Supplement_3/S269The Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics: miniMAGIC | American Academy of Pediatrics (aappublications.org)

https://pubmed.ncbi.nlm.nih.gov/21703801/Standard-length catheters vs long catheters in ultrasound-guided peripheral vein cannulation – PubMed (nih.gov)

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