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Clinical and demographic factors associated with pediatric difficult intravenous access in the operating room
Heather A Ballard1, John Hajduk1, Eric C Cheon1
1Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Insights
Pediatric difficult vascular access in the operating room is linked to Black non-Hispanic race, younger age, higher BMI, and American Society of Anesthesiologists physical status III. Ultrasound use also increased the odds of difficult access.
Area of Science:
- Pediatric Anesthesiology
- Vascular Access Procedures
- Ultrasound Guidance in Medicine
Background:
- Pediatric intravenous catheter insertion in the operating room presents unique challenges due to small vessel diameters and the urgency for access in anesthetized children.
- Limited research exists on factors influencing difficult vascular access in pediatric operating rooms, particularly concerning ultrasound guidance.
- Understanding these factors is crucial for optimizing patient care and procedural success.
Purpose of the Study:
- To identify demographic, clinical, and procedural factors associated with difficult pediatric vascular access in the operating room.
- To investigate the role of ultrasound guidance in pediatric difficult vascular access.
- To inform strategies for improving intravenous catheter insertion success rates in pediatric patients.
Main Methods:
- Retrospective analysis of prospectively collected data from 12,728 pediatric intravenous catheter insertions.
- Data collected from March 2020 to February 2021 at an academic tertiary care children's hospital.
- Multivariable analysis used to assess associations between difficult vascular access (>2 attempts) and various patient and procedural factors.
Main Results:
- Difficult vascular access was significantly associated with Black non-Hispanic race (OR 1.43), younger age (OR 0.93), overweight (OR 1.41), and obese BMI (OR 1.56).
- American Society of Anesthesiologists physical status III (OR 1.54) and ultrasound use (OR 2.61) were also linked to increased odds of difficult vascular access.
- Attending anesthesiologists had lower odds of difficult access compared to other practitioners.
Conclusions:
- Factors such as Black non-Hispanic race/ethnicity, younger age, higher BMI (overweight/obese), and ASA physical status III are associated with pediatric difficult vascular access.
- Ultrasound use, while a valuable tool, was found to be associated with a higher likelihood of difficult vascular access in this pediatric operating room cohort.
- These findings highlight the complexity of pediatric vascular access and the need for tailored approaches.
Background:
Pediatric intravenous catheter insertion can be difficult in the operating room due to the technical challenges of small diameter vessels and the need to rapidly gain intravenous access in anesthetized children. Few studies have examined factors associated with difficult vascular access in the operating room, especially accounting for the increased possibility to use ultrasound guidance.
Aims:
The primary aim of the study was to identify factors associated with pediatric difficult vascular access in the operating room. Our primary hypothesis was that Black race, Hispanic ethnicity, and ultrasound use would be associated with pediatric difficult vascular access.
Methods:
We performed a retrospective analysis of prospectively collected data from a cohort of pediatric patients who had intravenous catheters inserted in the operating room at an academic tertiary care children's hospital from March 2020 to February 2021. We measured associations among patients who were labeled as having difficult vascular access (>2 attempts at access) with demographic, clinical, and hospital factors.
Results:
12 728 intravenous catheter insertions were analyzed. Multivariable analysis showed significantly higher odds of difficult vascular access with Black non-Hispanic race (1.43, 95% CI: 1.06-1.93, p = .018), younger age (0.93, 95% CI: 0.89-0.98, p = .005), overweight (1.41, 95% CI: 1.04-1.90, p = .025) and obese body mass index (1.56, 95% 95% CI: 1.12-2.17, p = .008), and American Society of Anesthesiologists physical status III (1.54, 95% CI:1.11-2.13, p = .01). The attending anesthesiologist compared to all other practitioners (certified registered nurse anesthetist: (0.41, 95% CI: 0.31-0.56, p < .001, registered nurse: 0.25, 95% CI: 0.13-0.48, p < .001, trainee: 0.21, 95% CI: 0.17-0.28, p-value <.001 with attending as reference variable) and ultrasound use (2.61, 95% CI: 1.85-3.69, p < .001) were associated with successful intravenous catheter placement.
Conclusions:
Black non-Hispanic race/ethnicity, younger age, obese/overweight body mass index, American Society of Anesthesiologists physical status III, and ultrasound were all associated with pediatric difficult vascular access in the operating room.
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