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Updated: Jun 18, 2026
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Comparing peripheral venous access between obese and normal weight children
Olubukola O Nafiu1, Constance Burke, Andy Cowan
1Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109-0048, USA. onafiu@med.umich.edu
Insights
Obese children experience more difficulty with intravenous access compared to lean children. This study found obese children were more likely to require multiple attempts for successful peripheral intravenous (PIV) cannulation.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Medical Device Placement
Background:
- Peripheral intravenous (PIV) access is crucial for pediatric surgical procedures.
- Obesity is often anecdotally linked to challenges in achieving PIV access.
- Limited data exists on the objective relationship between body mass index (BMI) and PIV success in children.
Purpose of the Study:
- To investigate the association between body mass index (BMI) and the ease of peripheral intravenous (PIV) cannulation in pediatric patients undergoing noncardiac surgery.
- To determine if higher BMI correlates with increased difficulty in PIV placement.
Main Methods:
- Prospective data collection from 103 children (aged 2-18 years) undergoing elective noncardiac surgery.
- Recording patient demographics (age, gender, ethnicity, weight, height, BMI), PIV insertion details (site, attempts, operators, cannula size).
- Primary outcome: success of PIV placement on the first attempt, with a target sample size of 40 obese and 40 control patients.
Main Results:
- 55.2% of patients achieved PIV cannulation on the first attempt; 39.6% required 2-3 attempts.
- Obese children demonstrated a significantly higher likelihood of failed first attempts compared to lean controls (P < 0.001).
- Obese children were also significantly more likely to require two or more attempts for successful cannulation (P < 0.001).
Conclusions:
- Intravenous (IV) placement is demonstrably more challenging in obese children compared to their lean counterparts.
- The volar surface of the hand may offer a more successful IV access site in obese children following failed attempts on the dorsum of the hand.
- Understanding optimal IV access sites can enhance success rates, reduce patient distress, and improve procedural efficiency.
Introduction:
Intravenous (i.v.) access is sometimes a difficult, time-consuming, and highly frustrating procedure. Obesity is widely believed to be associated with difficult peripheral intravenous access (PIV) placement. This study examined the relationship between body mass index (BMI) and ease of venous access in children undergoing noncardiac surgical procedures.
Methods:
We prospectively collected data on children aged 2-18 years undergoing elective noncardiac surgery at our institution. A trained research assistant (RA) was present for PIV placement in all patients and noted the following: age, gender, ethnicity, weight, height, and BMI. We also collected data on i.v. insertion site, number of attempts, number of operators, and the number of i.v. cannula used. The main outcome variable was success or failure of i.v. placement on first attempt. Sample size calculation indicated a need for 40 obese and 40 control patients.
Results:
A total of 103 (56 lean and 47 obese) patients comprised the study population. PIV cannulation was achieved on the first attempt in 55.2% while 39.6% of patients had 2-3 attempts before successful cannulation. Obese children were more likely to have failed attempt at first cannulation than lean controls (P < 0.001). Similarly, obese children were more likely to require two or more attempts at cannulation than lean children (P < 0.001).
Conclusion:
These data indicate that i.v. placement is more difficult in obese children than their lean peers and that the most likely site for successful placement in obese children after a failed attempt on the dorsum of the hand is the volar surface of the hand. Knowledge of potential sites for successful i.v. access could help to improve the success rate for i.v. placement.
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