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Published on: August 9, 2024
Ultrasound-assisted peripheral venous access in young children: a randomized controlled trial and pilot feasibility
Aaron E Bair1, John S Rose, Cheryl W Vance
1University of California, Davis.
Insights
Ultrasound successfully visualized peripheral veins in children, but a static ultrasound-assisted technique did not significantly improve first-attempt success rates for intravenous cannulation in the emergency department compared to standard methods.
Area of Science:
- Pediatric Emergency Medicine
- Medical Ultrasound
- Vascular Access
Background:
- Intravenous (IV) access is crucial in pediatric emergency departments (EDs) but often challenging to achieve.
- Ultrasound has proven effective for venous access in adults, yet its utility in children remains less explored.
- Limited research exists on the effectiveness of ultrasound-guided peripheral venous cannulation in pediatric populations.
Purpose of the Study:
- To evaluate if a static ultrasound technique can enable visualization of peripheral veins in young children.
- To determine if ultrasound-assisted peripheral venous cannulation improves success rates in pediatric ED patients.
- To assess the efficacy of limited ultrasound training for clinicians performing pediatric IV access.
Main Methods:
- A randomized clinical trial was conducted in an academic pediatric ED involving children under 7 years old with failed first IV attempts.
- Patients were randomized to standard IV attempts or ultrasound-assisted attempts after brief (<1 hour) ultrasound training.
- Vein localization was performed by an ED physician using ultrasound, with nurses performing cannulation based on skin marks.
Main Results:
- Peripheral veins were visualized in all patients in the ultrasound group (n=23) and those who crossed over (n=8).
- First venipuncture success rates were similar between the ultrasound group (57%) and the standard group (57%).
- First attempt cannulation success rates showed no significant difference: 35% for ultrasound versus 29% for standard technique.
Conclusions:
- Static ultrasound effectively allows visualization of peripheral veins in young children within the ED setting.
- The study did not demonstrate a clinically significant benefit of this static ultrasound-aided technique over standard methods.
- Further research may be needed to optimize ultrasound-assisted venous cannulation protocols for pediatric emergency care.
Objectives:
Intravenous (IV) access in children treated in the emergency department (ED) is frequently required and often difficult to obtain. While it has been shown that ultrasound can be useful in adults for both central and peripheral venous access, research regarding children has been limited. We sought to determine if the use of a static ultrasound technique could, a) allow clinicians to visualize peripheral veins and b) improve success rates of peripheral venous cannulation in young children in the ED.
Methods:
We performed a randomized clinical trial of children < 7 years in an academic pediatric ED who required IV access and who had failed the first IV attempt. We randomized patients to either continued standard IV attempts or ultrasound-assisted attempts. Clinicians involved in the study received one hour of training in ultrasound localization of peripheral veins. In the ultrasound group, vein localization was performed by an ED physician who marked the skin overlying the target vessel. Intravenous cannulation attempts were then immediately performed by a pediatric ED nurse who relied on the skin mark for vessel location. We allowed for technique cross-over after two failed IV attempts. We recorded success rate and location of access attempts. We compared group success rates using differences in 95% confidence intervals (CI).
Results:
We enrolled 44 children over a one-year period. The median age of enrollees was 9.5 months. We visualized peripheral veins in all patients in the ultrasound group (n=23) and in those who crossed over to ultrasound after failed standard technique attempts (n= 8). Venipuncture was successful on the first attempt in the ultrasound group in 13/23 (57%, CI, 35% to 77%), versus 12/21 (57%, CI, 34% to 78%) in the standard group, difference between groups 0.6% (95% CI -30% to 29%). First attempt cannulation success in the ultrasound group was 8/23 (35%, CI, 16% to 57%), versus 6/21 (29%, CI, 11% to 52%) in the standard group, difference between groups 6% (95% CI -21% to 34%).
Conclusion:
Ultrasound allows physicians to visualize peripheral veins of young children in the ED. We were unable to demonstrate, however, a clinically important benefit to a static ultrasound aided vein cannulation technique performed by clinicians with limited ultrasound training over standard technique after one failed IV attempt in an academic pediatric ED.
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