In a July 2019 study published in Annals of Emergency Medicine, researchers determined that ultrasound-guided line insertions improves the first-attempt success rates over traditional palpation methods for children with predicted difficult access.
Previous research had shown successful first-attempt rates were approximately 75% for pediatric intravenous lines, with children with difficult access sometimes requiring multiple attempts.1, 2 Difficulty in obtaining line access often results in diagnostic and treatment delays as well as more pain and anxiety for the patient and family. If intravenous line access cannot be obtained, more invasive procedures could be required.
This study was conducted as a prospective, randomized controlled trial in an urban tertiary care pediatric emergency department. The 167 participants were randomized between traditional or ultrasound-guided intravenous line placements, and then divided between ages 0 to 3 and 3 and older. Physicians placed the majority of ultrasound-guided peripheral intravenous lines with a long catheter, while nurses placed all of the traditional peripheral intravenous lines with a short catheter.
First-attempt success rates were increased by 20% for the ultrasound-guided intravenous line placement compared with the traditional intravenous line placement. Ultrasound guided cannulation (n=83) had an 85% first-time success rate, while traditional placement (n=84) had a 46% first-time success rate. An analysis also showed that ultrasound-guided intravenous lines survived longer than traditional ones.3, 4 Moreover, parents were more satisfied with ultrasound-guided intravenous line placement.
The editors of the study concluded that more studies are needed to determine if this effect can carry over to the nurses, who place the majority of peripheral intravenous lines.
For the full study (including statistical charts and complete list of references), please review the original study.
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References
1Curtis SJ, Craig WR, Logue E, et al. Ultrasound or near-infrared vascular imaging to guide peripheral intravenous catheterization in children: a pragmatic randomized controlled trial. Canadian Emergency Medical Journal. 2015;187:563-570.
2Yen K, Riegert A, Gorelick MH. Derivation of the DIVA score: a clinical prediction rule for the identification of children with difficult intravenous access. Pediatric Emergency Care. 2008;24:143-147.
3Heinrichs J, Fritze Z, Vandermeer B, et al. Ultrasonographically guided peripheral intravenous cannulation of children and adults: a systematic review and meta-analysis. Annals of Emergency Medicine. 2013;61:444-454.e1.
4Fields JM, Dean AJ, Todman RW, et al. The effect of vessel depth, diameter, and location on ultrasound-guided peripheral intravenous catheter longevity. American Journal of Emergency Medicine. 2012;30:1134-1140.