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Pediatric intravenous insertion in the emergency department: bevel up or bevel down?

Karen J L Black1, Martin V Pusic, Debbie Harmidy

  • 1Department of Emergency Medicine and Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada. blackkjl@dal.ca

Pediatric Emergency Care
|November 11, 2005
PubMed

Insights

The standard bevel-up technique for intravenous catheter insertion is more successful than the bevel-down method in children. However, the bevel-down approach may be beneficial for infants under 5 kg.

Area of Science:

  • Pediatric Emergency Medicine
  • Vascular Access Procedures

Background:

  • Intravenous (IV) catheter insertion is a common procedure in pediatric emergency care.
  • The standard technique involves inserting the catheter with the bevel facing up.
  • An alternative bevel-down technique has been suggested for specific pediatric populations, such as small or dehydrated children.

Purpose of the Study:

  • To compare the first-attempt success rates of bevel-up versus bevel-down IV catheter insertion in children.
  • To evaluate if the bevel-down technique offers advantages in specific pediatric subgroups.

Main Methods:

  • A randomized controlled trial was conducted in a pediatric emergency department.
  • Children requiring IV access were randomized to either the bevel-up or bevel-down technique for their first insertion attempt.
  • The alternate technique was used for the second attempt if the first was unsuccessful.

Main Results:

  • A total of 396 children had data available for analysis.
  • The first-attempt success rate was significantly higher for the bevel-up technique (75.6%) compared to the bevel-down technique (60%).
  • In infants weighing less than 5 kg, no significant difference in first-attempt success rates was observed between the two techniques.

Conclusions:

  • The bevel-up technique demonstrates superior success rates for IV catheter insertion in the general pediatric population studied.
  • The bevel-down technique may have a role in very small infants, although further research is warranted.
  • Standardizing IV insertion techniques based on patient size may improve outcomes.
Abstract

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