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Techniques and Technologies to Improve Peripheral Intravenous Catheter Outcomes in Pediatric Patients: Systematic
Tricia M Kleidon1,2,3,4, Jessica Schults1,2,3,4, Claire M Rickard1,2,3,4
1Queensland Children's Hospital, Queensland, Australia.
Insights
Ultrasound guidance significantly improves first-time pediatric peripheral intravenous catheter (PIVC) insertion success. Near-infrared technology reduces insertion time and aids difficult access cases, though more research is needed.
Area of Science:
- Pediatric emergency medicine
- Medical device technology
- Clinical nursing
Background:
- Pediatric peripheral intravenous catheter (PIVC) insertion is challenging.
- Improving PIVC outcomes is crucial for patient care.
Purpose of the Study:
- To systematically review techniques and technologies for enhancing pediatric PIVC insertion success.
- To evaluate the impact of ultrasound and near-infrared technologies on PIVC outcomes.
Main Methods:
- Systematic review of English-language pediatric trials published post-2010.
- Data extraction and quality appraisal using Cochrane standards and GRADE.
- Meta-analysis of outcomes including first-time insertion success, overall success, and insertion time.
Main Results:
- Ultrasound guidance significantly increased first-time PIVC insertion success (RR, 1.60).
- Near-infrared technology reduced PIVC insertion time (MD, -132.47) and improved success in difficult access cases (RR, 2.72).
- Overall PIVC success was not significantly improved by ultrasound, and near-infrared had no significant effect on first-time success or number of attempts.
Conclusions:
- Ultrasound and near-infrared technologies show promise in improving pediatric PIVC insertion.
- Further high-quality research is needed to fully assess these and other PIVC technologies.
Objective:
Insertion and function of pediatric peripheral intravenous catheters (PIVCs) present challenges. We systematically reviewed techniques and technologies to improve PIVC outcomes (first-time insertion success, overall insertion success, time to insertion, dwell time, failure, and complications).
Data Sources:
Cochrane Central Register of Controlled Trials (CONTROL), Cumulative Index to Nursing and Allied Health (CINAHL), US National Library of Medicine, and Embase.
Study Selection:
English-language pediatric trials published post 2010 reporting PIVC outcomes.
Data Extraction:
Following Cochrane standards, two authors screened, extracted, and critiqued study quality (Grading of Recommendations Assessment, Development and Evaluation approach) data, random effects analysis, results expressed as risk ratios (RR), mean differences (MD) and 95% CIs.
Results:
Twenty-one studies (3237 children; 3098 PIVCs) were included. First-time insertion success significantly increased with ultrasound guidance (compared with landmark insertion; RR, 1.60; 95% CI, 1.02-2.50). Use of ultrasound guidance (compared with landmark insertion) did not improve overall PIVC insertion success (RR, 1.10; 95% CI, 0.94-1.28). There was no evidence of an effect of near-infrared (compared with landmark) on first-time insertion success (RR, 1.21; 95% CI, 0.91-1.59) or number of attempts (MD, -0.65; 95% CI, -1.59 to 0.29); however, it significantly reduced PIVC insertion time (MD, -132.47; 95% CI, -166.68 to -98.26) and increased first-time insertion success in subgroup analysis of patients with difficult intravenous access (RR, 2.72; 95% CI, 1.02-7.24).
Limitations:
Few studies per intervention, small sample sizes, and inconsistent outcome measures precluded definitive conclusions.
Conclusions:
Ultrasound and near-infrared appear to improve pediatric PIVC insertion. High-quality studies examining the full extent of techniques and technologies are needed. Registration: CRD42020175314.
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