Efficacy of long peripheral catheter (LPC) versus peripheral intravenous cannula (PIVC) for perioperative vascular access in high risk surgical patients - a randomised comparative trial

Venous access devices are an indispensable part of hospital care for surgical patients. Common indications for venous access devices are intravenous fluids, antibiotics, analgesics and supportive therapy. The duration of requirement of venous access device depends commonly on severity of patient’s illness, care plan, place of care and availability of alternate venous access sites. The surgical cohort has unique venous access requirements namely rapid fluid replacement during anesthesia, blood transfusions, short term peripheral administration of vasopressors in the operating room, antibiotic therapy for more than 7 days and prolonged intravenous fluid administration in patients undergoing laparotomies.

Peripheral intravenous cannula is the most frequently employed devices during patient admission but are associated with a failure rate of 40- 60 %.The common indications for PIVC removal are thrombophlebitis and catheter occlusion. Patients suffer from repeated pricks, interruption of therapy and dissatisfaction during hospital stay due to multiple PIVC insertions. The recommended dwell time for PIVC is 72 - 96 hours and thus are not right devices in patients requiring venous access more than 5 days. Long peripheral catheters are similar in design to peripheral intravenous cannula but are longer in length 8 - 10 cm and are inserted in veins above cubital fossa. They end distal to the axilla and have a median dwell time of 14 days. Ultrasound guided insertion success rates are 86 - 100 % for these catheters and have a failure rate of 14 % when compared with 42 % for PIVC.  LPCs have been studied in post cardiac surgery units and have been found to have longer dwell time and lower failure rate than PIVCs but such data regarding general perioperative cohort is lacking. Hence, we designed this trial to compare the efficacy of PIVC and LPC in surgical patients requiring venous access for 7 - 15 days in terms of device failure, average dwell time, costs of VAD, and complications such as phlebitis, occlusion and dislodgement.