Randomized controlled trial of ultrasound-guided peripheral intravenous catheter placement versus traditional techniques in difficult-access pediatric patients

Ultrasound equipment for the pediatric emergency department: a review

Ultrasound is gaining momentum for use in the pediatric emergency department. It is important to understand the fundamentals of ultrasound equipment as it relates to pediatric emergency medicine.

Efficacy of a near-infrared light device in pediatric intravenous cannulation: a randomized controlled trial

OBJECTIVES

To determine whether the use of a near-infrared light venipuncture aid (VeinViewer; Luminetx Corporation, Memphis, Tenn) would improve the rate of successful first-attempt placement of intravenous (IV) catheters in a high-volume pediatric emergency department (ED).

METHODS

Patients younger than 20 years with standard clinical indications for IV access were randomized to have IV placement by ED nurses (in 3 groups stratified by 5-year blocks of nursing experience) using traditional methods (standard group) or with the aid of the near-infrared light source (device group). If a vein could not be cannulated after 3 attempts, patients crossed over from one study arm to the other, and study nurses attempted placement with the alternative technique. The primary end point was first-attempt success rate for IV catheter placement. After completion of patient enrollment, a questionnaire was completed by study nurses as a qualitative assessment of the device.

RESULTS

A total of 123 patients (median age, 3 years) were included in the study: 62 in the standard group and 61 in the device group. There was no significant difference in first-attempt success rate between the standard (79.0%, 95% confidence interval [CI], 66.8%-88.3%) and device (72.1%, 95% CI, 59.2%-82.9%) groups. Of the 19 study nurses, 14 completed the questionnaire of whom 70% expressed neutral or unfavorable assessments of the device in nondehydrated patients without chronic underlying medical conditions and 90% found the device a helpful tool for patients in whom IV access was difficult.

CONCLUSIONS

First-attempt success rate for IV placement was nonsignificantly higher without than with the assistance of a near-infrared light device in a high-volume pediatric ED. Nurses placing IVs did report several benefits to use of the device with specific patient groups, and future research should be conducted to demonstrate the role of the device in these patients.

Transillumination by light-emitting diode facilitates peripheral venous cannulations in infants and small children

BACKGROUND

Transillumination facilitates the visualization of peripheral veins in infants and children. The clinical usefulness of light-emitting diode (LED)-powered devices has not been thoroughly studied.

METHODS

We randomly assigned 136 infants and children weighing <15 kg, undergoing general anesthesia, to red LED-powered transillumination (TM group, n=67) vs. the usual method (UM group, n=69) of peripheral venous cannulations. Venous puncture was performed following anesthesia induction with sevoflurane and nitrous oxide. The primary and secondary study endpoints were the rate of successful cannulations at initial attempt, and the duration of insertion attempts, respectively.

RESULTS

The median score of the estimated cannulation difficulty before attempted puncture was similar in both groups. The success rates at first attempt were 75% and 61% (NS) and mean+/-SD times to successful venous access were 47+/-34 and 68+/-66 s (NS) in the TM and UM groups, respectively. The cannulation procedures were completed significantly earlier in the TM group than in the UM group (hazard ratio, 1.59; 95% confidence interval, 1.03-2.47; P=0.03). In the subgroup of infants and children <2 years old, venous cannulation was successful at first attempt in 73% and 49% in the TM group (n=44) and in the UM group (n=47), respectively (P=0.03).

CONCLUSIONS

LED-powered transillumination devices facilitated peripheral venous cannulations in small infants and children.

ED technicians can successfully place ultrasound-guided intravenous catheters in patients with poor vascular access

OBJECTIVE

The objective of the study was to assess the success rate of emergency department (ED) technicians in placing ultrasound (US)-guided peripheral intravenous (i.v.) catheters.

METHODS

In this prospective, observational trial, 19 ED technicians were taught to use US guidance to obtain i.v. access. Training sessions consisted of didactic instruction and hands-on practice. The ED technicians were then prospectively followed. The US guidance for i.v. access was limited to patients with difficult access. The primary outcome was successful peripheral i.v. placement.

RESULTS

A total of 219 attempts were recorded, with a success rate of 78.5% (172/219). There was a significant correlation between operator experience and success rate. Complications were reported in 4.1% of patients and included 5 arterial punctures and 1 case of a transient paresthesia.

CONCLUSIONS

Emergency department technicians can be taught to successfully place US-guided IVs in patients with difficult venous access. Teaching this skill to ED technicians increases the pool of providers available in the ED to obtain access in this patient population.