{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T17:55:46Z","timestamp":1782496546269,"version":"3.54.5"},"reference-count":56,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"unspecified","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,1,18]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Ultrasound-guided peripheral cannulation by specialised nurses is increasingly used to improve first-stick success rates in patients with difficult intravenous access (DIVA). Long peripheral catheters are indicated for extended dwell times and the reduction of central venous catheters and their associated complications. Recently, multiple types of catheters and insertion techniques have been used in clinical care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This prospective, two-arm, single-centre, non-blinded, pragmatic randomised controlled trial will compare two types of long peripheral catheters. A 63\u2009mm ultra-long peripheral catheter using the catheter-over-needle approach will be compared with an 80\u2013100\u2009mm accelerated Seldinger technique-long peripheral catheter, which is the standard of care. Adult inpatients with DIVA, requiring a long peripheral catheter, will be included. The study aims to compare the mean dwell time, therapy completion rates and incidences of catheter-related thrombosis, infections, phlebitis, infiltration, loss of catheter usability and unplanned removal among adult DIVA patients. A priori sample size calculation based on average dwell times from published studies indicates that a minimum of 52\u2009patients (26 per group) is needed. Consecutive sampling will be used until the sample size is reached. Upon signing the informed consent form, patients will be randomised in a 1:1 ratio using sequentially numbered, opaque, sealed envelopes. Due to the distinct visual differences between the two types of long peripheral catheters, blinding the inserter during the procedure is impractical.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The ethics committee of Ghent University (B6702024000487) and University Hospital of Brussels approved this study. On completion of the study, results will be disseminated via publication in a relevant peer-reviewed scientific journal. No external funding was received for the execution of this trial. The authors declare no conflicts of interest.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT07005310\">NCT07005310<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Protocol version<\/jats:title>\n                    <jats:p>Version 1, 17\/03\/2025.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-106079","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T14:55:32Z","timestamp":1770389732000},"page":"e106079","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Ultra long peripheral catheter versus accelerated Seldinger technique long peripheral catheter in difficult intravenous access patients (ULAST): a pragmatic randomised controlled trial protocol"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct07005310","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5595-3007","authenticated-orcid":false,"given":"Wouter","family":"Pieteraerens","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium"},{"name":"Departement of Anaesthesiology and Perioperative Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium"},{"name":"Nursing and Midwifery Research Group (NUMID), Universitair Ziekenhuis Brussel, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domien","family":"Vanhonacker","sequence":"additional","affiliation":[{"name":"Departement of Anaesthesiology and Perioperative Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrien","family":"Beeckman","sequence":"additional","affiliation":[{"name":"Nursing and Midwifery Research Group (NUMID), Universitair Ziekenhuis Brussel, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2495-1690","authenticated-orcid":false,"given":"Tim","family":"Torsy","sequence":"additional","affiliation":[{"name":"Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium"},{"name":"Department of Nursing, Cluster Health, Odisee University College, Sint-Niklaas, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,2,6]]},"reference":[{"key":"2026062610410655000_16.2.e106079.1","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.2389"},{"key":"2026062610410655000_16.2.e106079.2","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1177\/11297298211023274","article-title":"European recommendations on the proper indication and use of peripheral venous access devices (the ERPIUP consensus): A WoCoVA project","volume":"24","author":"Pittiruti","year":"2023","journal-title":"J Vasc Access"},{"key":"2026062610410655000_16.2.e106079.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2021.104095"},{"key":"2026062610410655000_16.2.e106079.4","doi-asserted-by":"crossref","DOI":"10.3390\/jcm8020144","article-title":"The Modified A-DIVA Scale as a Predictive Tool for Prospective Identification of Adult Patients at Risk of a Difficult Intravenous Access: A Multicenter Validation Study","volume":"8","author":"van Loon","year":"2019","journal-title":"J Clin Med"},{"key":"2026062610410655000_16.2.e106079.5","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-022278","article-title":"Factors associated with peripheral intravenous cannulation first-time insertion success in the emergency department. A multicentre prospective cohort analysis of patient, clinician and product characteristics","volume":"9","author":"Carr","year":"2019","journal-title":"BMJ Open"},{"key":"2026062610410655000_16.2.e106079.6","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1016\/j.ajem.2014.07.008","article-title":"Risk factors associated with difficult venous access in adult ED patients","volume":"32","author":"Fields","year":"2014","journal-title":"Am J Emerg Med"},{"key":"2026062610410655000_16.2.e106079.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2012.07.051"},{"key":"2026062610410655000_16.2.e106079.8","first-page":"93","article-title":"Failed attempts and improvement strategies in peripheral intravenous catheterization","volume":"23","author":"Sabri","year":"2013","journal-title":"Biomed Mater Eng"},{"key":"2026062610410655000_16.2.e106079.9","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-007-0634-y"},{"key":"2026062610410655000_16.2.e106079.10","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1097\/NAN.0000000000000535","article-title":"An Improved Definition and SAFE Rule for Predicting Difficult Intravascular Access (DIVA) in Hospitalized Adults","volume":"47","author":"Bahl","year":"2024","journal-title":"J Infus Nurs"},{"key":"2026062610410655000_16.2.e106079.11","doi-asserted-by":"publisher","DOI":"10.4103\/2229-5151.164940"},{"key":"2026062610410655000_16.2.e106079.12","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra011883"},{"key":"2026062610410655000_16.2.e106079.13","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1177\/1129729818761276","article-title":"The incidence of symptomatic upper limb venous thrombosis associated with midline catheter: Prospective observation","volume":"19","author":"Lisova","year":"2018","journal-title":"J Vasc Access"},{"key":"2026062610410655000_16.2.e106079.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2018.04.047"},{"key":"2026062610410655000_16.2.e106079.15","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1016\/j.ajic.2018.01.006","article-title":"Comparison of complications in midlines versus central venous catheters: Are midlines safer than central venous lines?","volume":"46","author":"Mushtaq","year":"2018","journal-title":"Am J Infect Control"},{"key":"2026062610410655000_16.2.e106079.16","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.jemermed.2016.05.029","article-title":"The Midline Catheter: A Clinical Review","volume":"51","author":"Adams","year":"2016","journal-title":"J Emerg Med"},{"key":"2026062610410655000_16.2.e106079.17","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1177\/11297298231162132","article-title":"UltraSound guided PEripheral Catheterization increases first-atTempt success RAte in hospitalized patients when compared with conventional technique: SPECTRA - Randomized Clinical Trial","volume":"25","author":"Hansel","year":"2024","journal-title":"J Vasc Access"},{"key":"2026062610410655000_16.2.e106079.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2016.06.098"},{"key":"2026062610410655000_16.2.e106079.19","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.jen.2011.02.011","article-title":"Implementation of a successful registered nurse peripheral ultrasound-guided intravenous catheter program in an emergency department","volume":"38","author":"Miles","year":"2012","journal-title":"J Emerg Nurs"},{"key":"2026062610410655000_16.2.e106079.20","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1016\/j.ajem.2020.11.013","article-title":"Difficult intravenous access in the emergency department: Performance and impact of ultrasound-guided IV insertion performed by nurses","volume":"46","author":"Davis","year":"2021","journal-title":"Am J Emerg Med"},{"key":"2026062610410655000_16.2.e106079.21","doi-asserted-by":"publisher","DOI":"10.1097\/PTS.0000000000000246"},{"key":"2026062610410655000_16.2.e106079.22","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/j.ajic.2019.08.019","article-title":"A comprehensive vascular access service can reduce catheter-associated bloodstream infections and promote the appropriate use of vascular access devices","volume":"48","author":"Martillo","year":"2020","journal-title":"Am J Infect Control"},{"key":"2026062610410655000_16.2.e106079.23","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1097\/NAN.0000000000000328","article-title":"Implementation of a Vascular Access Team to Reduce Central Line Usage and Prevent Central Line-Associated Bloodstream Infections","volume":"42","author":"Savage","year":"2019","journal-title":"J Infus Nurs"},{"key":"2026062610410655000_16.2.e106079.24","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.java.2016.12.002","article-title":"Positive Influence of a Dedicated Vascular Access Team in an Acute Care Hospital","volume":"22","author":"Johnson","year":"2017","journal-title":"J Assoc Vasc Access"},{"key":"2026062610410655000_16.2.e106079.25","doi-asserted-by":"crossref","first-page":"255","DOI":"10.5301\/jva.5000730","article-title":"Teaching medical students ultrasound-guided vascular access - which learning method is best?","volume":"18","author":"Lian","year":"2017","journal-title":"J Vasc Access"},{"key":"2026062610410655000_16.2.e106079.26","doi-asserted-by":"crossref","first-page":"272","DOI":"10.7205\/MILMED-D-15-00056","article-title":"Ultrasound-Guided Peripheral Intravenous Access Program for Emergency Physicians, Nurses, and Corpsmen (Technicians) at a Military Hospital","volume":"181","author":"Oliveira","year":"2016","journal-title":"Mil Med"},{"key":"2026062610410655000_16.2.e106079.27","doi-asserted-by":"publisher","DOI":"10.7863\/ultra.15.11059"},{"key":"2026062610410655000_16.2.e106079.28","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1177\/11297298221122118","article-title":"Predictors of ultrasound-guided peripheral intravenous catheter failure: A secondary analysis of existing trial data","volume":"25","author":"Bahl","year":"2024","journal-title":"J Vasc Access"},{"key":"2026062610410655000_16.2.e106079.29","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.jemermed.2018.10.021","article-title":"Evaluation of Central Venous Access with Accelerated Seldinger Technique Versus Modified Seldinger Technique","volume":"56","author":"Thaut","year":"2019","journal-title":"J Emerg Med"},{"key":"2026062610410655000_16.2.e106079.30","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.java.2015.05.001","article-title":"How to Establish an Effective Midline Program: A Case Study of 2 Hospitals","volume":"20","author":"Moureau","year":"2015","journal-title":"J Assoc Vasc Access"},{"key":"2026062610410655000_16.2.e106079.31","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.annemergmed.2019.11.013","article-title":"Ultralong Versus Standard Long Peripheral Intravenous Catheters: A Randomized Controlled Trial of Ultrasonographically Guided Catheter Survival","volume":"76","author":"Bahl","year":"2020","journal-title":"Ann Emerg Med"},{"key":"2026062610410655000_16.2.e106079.32","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1177\/1757177420976806","article-title":"UK Vessel Health and Preservation (VHP) Framework: a commentary on the updated VHP 2020","volume":"22","author":"Hallam","year":"2021","journal-title":"J Infect Prev"},{"key":"2026062610410655000_16.2.e106079.33","doi-asserted-by":"crossref","unstructured":"Moureau NL . Vessel health and preservation: the right approach for vascular access.2019. Available: http:\/\/link.springer.com\/10.1007\/978-3-030-03149-7","DOI":"10.1007\/978-3-030-03149-7"},{"key":"2026062610410655000_16.2.e106079.34","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.ajem.2021.05.005","article-title":"Extended dwell and standard ultrasound guided peripheral intravenous catheters: Comparison of durability and reliability","volume":"47","author":"Fung","year":"2021","journal-title":"Am J Emerg Med"},{"key":"2026062610410655000_16.2.e106079.35","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.ijid.2020.10.053","article-title":"The efficacy of midline catheters\u2014a prospective, randomized, active-controlled study","volume":"102","author":"Nielsen","year":"2021","journal-title":"Int J Infect Dis"},{"key":"2026062610410655000_16.2.e106079.36","doi-asserted-by":"crossref","first-page":"S6","DOI":"10.1016\/j.idh.2021.09.023","article-title":"Midline pilot randomised controlled trial: Managing peripheral intravenous devices among adult hospital patients with limited vascular access or prolonged therapy trial","volume":"26","author":"Marsh","year":"2021","journal-title":"Infect Dis Health"},{"key":"2026062610410655000_16.2.e106079.37","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1016\/j.ajem.2018.07.031","article-title":"Standard long IV catheters versus extended dwell catheters: A randomized comparison of ultrasound-guided catheter survival","volume":"37","author":"Bahl","year":"2019","journal-title":"Am J Emerg Med"},{"key":"2026062610410655000_16.2.e106079.38","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.thromres.2024.02.022","article-title":"Complications associated to midline- and long peripheral catheters in adults. Systematic review of literature and proposal for a standardized model for data collection","volume":"236","author":"Fabiani","year":"2024","journal-title":"Thromb Res"},{"key":"2026062610410655000_16.2.e106079.39","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2024-081477","article-title":"SPIRIT 2025 statement: updated guideline for protocols of randomised trials","volume":"389","author":"Chan","year":"2025","journal-title":"BMJ"},{"key":"2026062610410655000_16.2.e106079.40","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1177\/11297298241291248","article-title":"The NAVIGATE project: A GloVANet-WoCoVA position statement on the nomenclature for vascular access devices","volume":"26","author":"van Rens","year":"2025","journal-title":"J Vasc Access"},{"key":"2026062610410655000_16.2.e106079.41","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-045895","article-title":"Catheter to vein ratio and risk of peripherally inserted central catheter (PICC)-associated thrombosis according to diagnostic group: a retrospective cohort study","volume":"11","author":"Sharp","year":"2021","journal-title":"BMJ Open"},{"key":"2026062610410655000_16.2.e106079.42","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1177\/11297298221099838","article-title":"The SIP protocol update: Eight strategies, incorporating Rapid Peripheral Vein Assessment (RaPeVA), to minimize complications associated with peripherally inserted central catheter insertion","volume":"25","author":"Brescia","year":"2024","journal-title":"J Vasc Access"},{"key":"2026062610410655000_16.2.e106079.43","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1097\/00129804-200611000-00004","article-title":"Evaluation of a visual infusion phlebitis scale for determining appropriate discontinuation of peripheral intravenous catheters","volume":"29","author":"Gallant","year":"2006","journal-title":"J Infus Nurs"},{"key":"2026062610410655000_16.2.e106079.44","doi-asserted-by":"publisher","DOI":"10.3758\/BRM.41.4.1149"},{"key":"2026062610410655000_16.2.e106079.45","doi-asserted-by":"publisher","DOI":"10.3758\/BRM.41.4.1149"},{"key":"2026062610410655000_16.2.e106079.46","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.hrtlng.2023.02.027","article-title":"The catheter-to-vein ratio at the tip level, not the catheter type, as a risk factor for a catheter failure. A retrospective comparative study of polyurethane midline and long peripheral catheters","volume":"60","author":"Fabiani","year":"2023","journal-title":"Heart Lung"},{"key":"2026062610410655000_16.2.e106079.47","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.4103\/njcp.njcp_843_22","article-title":"Midline Catheters in the Operating Room","volume":"26","author":"Lee","year":"2023","journal-title":"Niger J Clin Pract"},{"key":"2026062610410655000_16.2.e106079.48","doi-asserted-by":"crossref","DOI":"10.5758\/vsi.210062","article-title":"Efficacy and Safety of Midline Catheters with Integrated Wire Accelerated Seldinger Technique","volume":"38","author":"Jeon","year":"2022","journal-title":"Vasc Specialist Int"},{"key":"2026062610410655000_16.2.e106079.49","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1111\/aas.13516","article-title":"The clinical performance of midline catheters\u2014An observational study","volume":"64","author":"Bundgaard Madsen","year":"2020","journal-title":"Acta Anaesthesiol Scand"},{"key":"2026062610410655000_16.2.e106079.50","doi-asserted-by":"crossref","DOI":"10.1111\/ijn.13110","article-title":"Safety and efficacy of midline catheters versus peripheral intravenous catheters: A pilot randomized controlled trial","volume":"29","author":"Marsh","year":"2023","journal-title":"Int J Nurs Pract"},{"key":"2026062610410655000_16.2.e106079.51","doi-asserted-by":"crossref","first-page":"758","DOI":"10.12788\/jhm.3313","article-title":"Long Peripheral Catheters: A Retrospective Review of Major Complications","volume":"14","author":"Patel","year":"2019","journal-title":"J Hosp Med"},{"key":"2026062610410655000_16.2.e106079.52","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1097\/IPC.0000000000000237","article-title":"The Incidence of Central Line\u2013Associated Bacteremia After the Introduction of Midline Catheters in a Ventilator Unit Population","volume":"23","author":"Pathak","year":"2015","journal-title":"Infect Dis Clin Pract (Baltim Md)"},{"key":"2026062610410655000_16.2.e106079.53","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1016\/j.ajic.2019.11.004","article-title":"A comparison of the incidence of midline catheter-associated bloodstream infections to that of central line-associated bloodstream infections in 5 acute care hospitals","volume":"48","author":"Hogle","year":"2020","journal-title":"Am J Infect Control"},{"key":"2026062610410655000_16.2.e106079.54","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1097\/NAN.0000000000000326","article-title":"Accepted but Unacceptable","volume":"42","author":"Helm","year":"2019","journal-title":"J Infus Nurs"},{"key":"2026062610410655000_16.2.e106079.55","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1097\/01.NAN.0000300307.72906.69","article-title":"Standard 54","volume":"30","author":"Gorski","year":"2007","journal-title":"J Infus Nurs"},{"key":"2026062610410655000_16.2.e106079.56","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwq433"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-106079","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T17:43:04Z","timestamp":1782495784000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-106079"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":56,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,6]]},"published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1136\/bmjopen-2025-106079"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-106079","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]}}}