Is Aseptic Technique for Ultrasound Guided Peripheral Lines Enough?
Widespread use of ultrasound guided peripheral intravenous catheters will reduce reliance on central lines, thus decreasing the central line device utilization ratios (DUR). In theory and practice, high DURs correlate with high rates of central line associated blood stream infections (CLABSI). In addition to avoiding CLABSI, ultrasound guided peripheral lines can be placed rapidly and are associated with lower risk of mechanical complications. Current standards call for aseptic technique, as is done with routine peripheral IV starts. Peripherally inserted central catheters, however, are inserted using sterile technique as is done with central line insertion. The deep brachial IV catheter may pose a greater risk for bacteremia than a routine peripheral catheter, but I am not aware of any studies evaluating this. Many hospitals protect against the risk of peripheral IV associated blood stream infections by following policies that require removal of peripheral catheters within 72 hours. Now coming into widespread use are midline catheters such as the Bard PowerGlide. These are peripherally inserted lines, longer than routine catheters, but they do not reach the central circulation. Manufacturers are deferring to hospital policies for skin preparation. However, these catheters are now approved for 29 days of access. We need safety data on the placement of deep peripheral catheters using aseptic technique. Greater than 250,000 CLABSIs occur every year in the United States at an average cost of $30,000 per infection, two additional weeks of hospitalization and increased risk of death. We need to know that increasing use of ultrasound guided peripheral lines is not contributing to preventable morbidity and mortality.