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Effects of Local Warming on the Peripheral Vein Cross-Sectional Area in Children Under Sedation

Meili Chen¹, Jia Guo², Yu Wang²

¹Nursing Department, Capital Institute of Pediatrics, Beijing, China.

Journal of Perianesthesia Nursing : Official Journal of the American Society of Perianesthesia Nurses

|December 3, 2020

Insights

Local warming significantly increased cephalic vein size in sedated children, aiding peripheral venous catheterization. The basilic vein showed a smaller increase, suggesting targeted warming is most effective for specific veins.

Area of Science:

Pediatric Anesthesiology
Vascular Ultrasound
Medical Device Technology

Background:

Peripheral venous catheterization is difficult in young children.
Local warming can increase vein size and improve catheterization success.
Evidence on local warming's effect on venous size in sedated children is limited.

Purpose of the Study:

To evaluate the effect of local warming on peripheral venous cross-sectional area (CSA) in sedated children aged 1-4 years.
To determine if local warming improves venous CSA for easier catheterization.

Main Methods:

Pilot randomized controlled trial involving 35 children aged 1-4 years undergoing ambulatory surgery.
Children received intranasal dexmedetomidine for sedation.
Ultrasound measured cephalic and basilic vein CSA before and after applying a ~40°C hot pack for 5 minutes to the local warming group.

Main Results:

Local warming significantly increased cephalic vein CSA by 34% (4.1 to 5.5 mm²) and basilic vein CSA by 21% (4.8 to 5.8 mm²).
Cephalic vein CSA showed a significant difference between groups post-intervention.
No significant difference in basilic vein CSA was observed between groups.

Conclusions:

Local warming induces mild venodilation, significantly increasing cephalic vein CSA in sedated children.
The effect on basilic vein CSA was less pronounced.
Local warming shows potential for improving peripheral venous access in pediatric patients.

Read full analysis

Abstract

Purpose:

Peripheral venous catheterization is challenging in small children. The local warming technique has been used to increase the peripheral vein cross-sectional area (CSA) and improve the success rate. However, there is limited evidence on the effect of local warming on venous CSA in children under sedation.

Design:

A pilot randomized controlled trial.

Methods:

Eligible children aged 1 to 4 years undergoing ambulatory surgery were enrolled. At the bedside in the ambulatory surgery center, they were routinely sedated with 1 mcg/kg of intranasal dexmedetomidine. Through a computer allocation program, children were randomized into either a control group or a local warming group. Cephalic vein and basilic vein at 1 cm proximal to cubital fossa were scanned with ultrasound to measure venous CSA. Children in the control group received no intervention; those in the local warming group had a prepared hot pack of ~40°C applied to the target area on the arm for 5 minutes. A second ultrasound measurement was undertaken in both groups.

Findings:

A total of 35 from 40 children were analyzed. Cephalic vein CSA and basilic vein CSA increased significantly vs the first measurement within the local warming group (P < .05 for both) but not in the control group (P > .05 for both). Cephalic vein CSA was significantly different between groups at the second measurement (P < .05) but not at the first measurement (P > .05). Basilic vein CSA was significantly different between groups neither at the first measurement nor at the second measurement (P > .05 for both). The application of local warming resulted in an average of 34% increase (from 4.1 to 5.5 mm²) in cephalic vein CSA and an average of 21% increase (from 4.8 to 5.8 mm²) in basilic vein CSA.

Conclusions:

The application of local warming induced mild venodilation in cephalic vein with an increase in CSA by 34% and had little venodilation effect on the basilic vein with an increase in CSA by only 21%.

Keywords:

children local warming sedation venodilation

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