Authors' objectives: Insertion of peripheral intravenous catheters (PIVCs) is the most common invasive procedure performed in acute healthcare, with approximately 90% of hospitalised patients requiring a PIVC. For people with difficult venous access, multiple attempts at cannulation are required, which may cause pain and/or discomfort. The use of longer PIVCs, ranging from 6 to 15 cm in length, may reduce the number of failed insertions and may have longer dwell times than shorter PIVCs. This report aims to identify and summarise evidence that addresses the following question: what is the clinical and cost-effectiveness of long peripheral intravenous catheters for people with difficult venous access?

Authors' results and conclusions: Two randomised controlled trials (RCTs) and one observational study were identified that compared long peripheral intravenous catheters (LPCs) to short peripheral intravenous catheters (SPCs) in people with difficult intravenous access (DIVA). Two observational studies compared LPCs to midline catheters (MCs) in people with DIVA. No studies were found that compared LPCs to peripherally inserted central catheters (PICCs) in people with DIVA. Three systematic reviews, and three additional studies published since these reviews, provided evidence from non-comparative studies of LPCs in people with DIVA. The evidence suggests that LPCs may have an advantage over SPCs in terms of dwell time and catheter failure. Limited evidence from non-randomised studies, however, indicates that LPCs are at a disadvantage compared to MCs in terms of dwell time and catheter failure. Qualitative evidence of peoples’ experiences of DIVA highlighted its distress and emotional impact, with pain and discomfort caused by repeated insertion attempts. Two UK economic analyses suggested that the insertion of an LPC costs more than the insertion of a single SPC but less than the insertion of an MC or multiple SPCs. Three additional studies suggested that LPC may save costs compared with MC, PICC or repeated SPCs in countries outside the UK. New economic analysis for Wales suggests that the cost effectiveness of LPC inserted catheter over needle depends on the planned duration of treatment when compared against ultrasound-guided SPC. LPC was estimated to be cost effective for treatment durations of four to 14 days versus SPC, because it was less costly and more effective in terms of catheter failures. For durations shorter than four days, LPC was estimated to be more costly and more effective than SPC. By contrast, LPC inserted catheter over guidewire was estimated to be less costly and less effective than MC. Evidence on the impact of catheter insertions, complications and failures on patients’ quality of life is limited. Consequently, the cost effectiveness of LPC compared with MC or compared with SPC over short horizons remains unclear.

Authors' recommendations: Long peripheral intravenous catheters (LPCs) inserted catheter over needle should be routinely available as an alternative to short peripheral intravenous catheters (SPCs) for people with difficult intravenous access whose need for intravenous access is expected to last between four and 14 days. In other scenarios, LPCs show promise but the evidence is insufficient to support routine adoption. Evidence suggests that LPCs may have an advantage over SPCs in terms of dwell time and catheter failure. Evidence also indicates that LPCs are at a disadvantage compared with midline catheters (MCs) in terms of dwell time and catheter failure, but there is less certainty in this finding. Economic modelling suggests that LPCs inserted catheter over needle are cost effective for treatment durations of four to 14 days compared with SPCs. The cost effectiveness of LPCs compared with MCs or compared with SPCs over shorter treatment durations was unclear.

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Project Status: Completed

Year Published: 2025

URL for published report: https://healthtechnology.wales/reports-guidance/long-length-peripheral-intravenous-catheters/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk