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Published on: August 9, 2024
Ultrasound guidance allows faster peripheral IV cannulation in children under 3 years of age with difficult venous
Mehdi Benkhadra1, Mathieu Collignon, Isabelle Fournel
1Department of Anesthesiology and Intensive Care, University Hospital Bocage, Dijon, France. mehdi.benkhadra@gmail.com
Insights
Ultrasound-guided peripheral venous access (USG-PIVA) significantly reduces cannulation time and the number of punctures in young children. This technique is recommended for difficult venous access cases in pediatric anesthesia.
Area of Science:
- Pediatric Anesthesiology
- Medical Imaging
- Vascular Access
Background:
- Difficult venous access is common in pediatric patients, particularly those under 3 years old.
- Ultrasound-guided peripheral venous access (USG-PIVA) offers potential advantages over traditional blind techniques.
- Establishing peripheral IV access is crucial for administering anesthesia and medications.
Purpose of the Study:
- To compare the efficacy of USG-PIVA versus the blind technique for peripheral venous access in children under 3 years undergoing general anesthesia.
- To evaluate key metrics including cannulation time, success rate, and number of punctures.
Main Methods:
- A randomized controlled trial involving children under 3 years with difficult venous access scheduled for general anesthesia.
- Participants were randomized into two groups: ultrasound-guided (USG-PIVA) and blind cannulation.
- Primary endpoint was time to cannulation; secondary outcomes included first-puncture success rate and number of punctures.
Main Results:
- USG-PIVA demonstrated significantly faster median cannulation times (63.5s vs 420.5s) compared to the blind technique (P < 0.001).
- The first-puncture success rate was higher with USG-PIVA (85% vs 35%, P = 0.0012).
- USG-PIVA required fewer punctures (median 1 vs 2.5, P = 0.004), though overall success rates were similar (90% vs 85%).
Conclusions:
- Ultrasound-guided peripheral venous access is a superior method for achieving faster peripheral IV access in pediatric patients with difficult venous access.
- USG-PIVA should be recommended in pediatric anesthesia settings to improve efficiency and patient care.
- The technique enhances first-attempt success and reduces patient discomfort associated with multiple punctures.
Objectives:
Ultrasound-guided peripheral venous access (USG-PIVA) presents many advantages over the reference 'blind' technique in both adults and children in emergency situations.
Aim:
To compare USG-PIVA with the blind technique in children <3 years undergoing general anesthesia.
Methods:
After obtaining the approval of the ethics committee and informed consent from the parents, we included all children <3 years scheduled to undergo general anesthesia [surgery, magnetic resonance imaging (MRI)], who presented difficult venous access. The children were randomized into two groups: the US group (USG-PIVA) and the B group (blind). The primary endpoint was time to cannulation (from tourniquet placement to successful IV cannulation), compared between USG-PIVA group and B group by intention-to-treat analysis. Secondary outcomes were success rate at the first puncture, number of punctures, and diameter of the catheters. Cannulations requiring >15 min were considered as failures. In case of failure in group B, USG-PIVA was attempted for a further 15 min.
Results:
Twenty children were included in each group. Groups were comparable for sex, age, and BMI. Significant differences were observed in median time to cannulation (63.5 s vs 420.5 s, USG-PIVA vs B respectively, P < 0.001); median number of punctures (1 vs 2.5, USG-PIVA vs B, P = 0.004); and success rate at first cannulation (85% vs 35%, USG-PIVA vs B, P = 0.0012). In contrast, overall success rate did not differ significantly between groups (90% vs 85%, USG-PIVA vs B, P = 0.63).
Conclusions:
Ultrasound-guided peripheral venous access leads to faster peripheral IV access and should therefore be recommended in children presenting with difficult venous access.
