Impact of Accelerated Seldinger Technique long peripheral catheters on catheter related outcomes: a systematic review and meta-analysis

Managing intravenous therapy in patients with difficult intravenous access (DIVA) often requires the use of midline catheters (MCs) or long peripheral catheters (LPCs). This study aimed to review and meta-analyze catheter-related outcomes of LPCs inserted using the Accelerated Seldinger Technique (AST) in adult DIVA patients, focusing on dwell time, catheter-related infections, thrombosis, infiltration, occlusion, phlebitis and other outcomes. A systematic review was conducted on quantitative studies from 2000 to 2023, sourced from databases including CINAHL, Cochrane Library, Google Scholar and PubMed, to identify studies on adult DIVA patients requiring AST-LPCs. The review adhered to PRISMA guidelines, and the Quality Assessment Tool for Quantitative Studies was used to ensure rigorous evaluation. Of 1017 records initially reviewed, 11 studies were included in the final analysis. The mean dwell time for LPCs ranged from 2.92 (± 0.54) to 17.1 (± 12.3) days. A meta-analysis showed a significant mean difference in dwell time of 1.98 days (± 1.16 to 2.80) in favor of LPCs over short peripheral catheters (p < 0.00001). Reported complications included infiltration (up to 24%), dysfunction (up to 15.7%), thrombosis (up to 15.4%), catheter-related infections (up to 10.2%), occlusion (up to 10.2%) and phlebitis (up to 9.8%). The findings suggest that AST-LPCs may offer greater durability than short peripheral catheters in DIVA patients. While MCs may be more effective for therapies exceeding four weeks, they involve higher procedural complexities. This review highlights the need for high-quality randomized studies comparing AST-LPCs, MCs, and newer catheter-over-needle LPCs to better inform vascular access specialists in managing DIVA patients. Prospero ID: CRD42023425513