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Ultrasound or near-infrared vascular imaging to guide peripheral intravenous catheterization in children: a pragmatic
Sarah J Curtis1, William R Craig2, Erin Logue2
1Department of Pediatrics (Curtis, Craig, Logue), University of Alberta; Alberta Research Centre for Health Evidence (Vandermeer); Department of Emergency Medicine (Hanson), University of Alberta; Women and Children's Health Research Institute (Curtis, Craig), Edmonton, Alta.; Manitoba Institute of Child Health and College of Medicine (Klassen), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man. scurtis@ualberta.ca.
Insights
Ultrasound and near-infrared imaging did not improve first-attempt success rates for pediatric peripheral intravenous catheterization compared to the standard approach. These imaging technologies are not recommended for routine use in children.
Area of Science:
- Pediatric Emergency Medicine
- Medical Imaging
- Vascular Access
Background:
- Peripheral intravenous catheterization in children presents significant challenges.
- Success rates for first-attempt catheterization vary widely.
- Novel imaging techniques are being explored to improve procedural success.
Purpose of the Study:
- To compare the effectiveness of ultrasound and near-infrared vascular imaging versus the standard approach for pediatric peripheral intravenous catheterization.
- To determine if imaging guidance improves first-attempt success rates in children.
- To assess efficacy in different age groups within the pediatric population.
Main Methods:
- A pragmatic randomized controlled trial involving 418 children requiring peripheral intravenous catheterization.
- Participants were stratified by age (≤ 3 years and > 3 years).
- Random assignment to standard approach, ultrasound imaging, or near-infrared imaging groups.
Main Results:
- No statistically significant difference in first-attempt success rates was found between ultrasound or near-infrared imaging and the standard approach.
- Near-infrared imaging showed a significantly worse success rate in children 3 years and younger (-20.1%).
- No significant differences were observed in any subgroup or outcome comparison.
Conclusions:
- Neither ultrasound nor near-infrared vascular imaging enhanced first-attempt success rates for peripheral intravenous catheterization in children.
- The study does not support the routine adoption or investment in these technologies for pediatric catheterization.
- Further research may be needed to identify optimal strategies for difficult venous access in pediatric patients.
Background:
Peripheral intravenous catheterization in children is challenging, and success rates vary greatly. We conducted a pragmatic randomized controlled trial to determine whether the use of ultrasound or near-infrared vascular imaging to guide catheterization would be more effective than the standard approach in achieving successful catheter placement on the first attempt.
Methods:
We enrolled a convenience sample of 418 children in a pediatric emergency department who required peripheral intravenous catheterization between June 2010 to August 2012. We stratified them by age (≤ 3 yr and > 3 yr) and randomly assigned them to undergo the procedure with the standard approach, or with the help of either ultrasound or near-infrared vascular imaging. The primary outcome was the proportion of patients who had successful placement of a catheter on the first attempt.
Results:
The rate of successful first attempts did not differ significantly between either of the 2 intervention groups and the standard approach group (differences in proportions -3.9%, 95% confidence interval [CI] -14.2% to 6.5%, for ultrasound imaging; -8.7%, 95% CI -19.4% to 1.9%, for near-infrared imaging). Among children 3 years and younger, the difference in success rates relative to standard care was also not significant for ultrasound imaging (-9.6%, 95% CI -29.8% to 10.6%), but it was significantly worse for near-infrared imaging (-20.1%, 95% CI -40.1% to -0.2%). Among children older than 3 years, the differences in success rates relative to standard care were smaller but not significant (-2.3%, 95% CI -13.6% to 9.0%, for ultrasound imaging; -4.1%, 95% CI -15.7% to 7.5%, for near-infrared imaging). None of the pairwise comparisons were statistically significant in any of the outcomes.
Interpretation:
Neither technology improved first-attempt success rates of peripheral intravenous catheterization in children, even in the younger group. These findings do not support investment in these technologies for routine peripheral intravenous catheterization in children.
Trial Registration:
ClinicalTrials.gov, no. NCT01133652.
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