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Ultrasound for Pediatric Peripheral Intravenous Catheter Insertion: A Systematic Review
Evan O Mitchell1,2, Philip Jones1,3,4, Peter J Snelling1,3,5,6
1School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia.
Insights
Ultrasound significantly improves first-attempt success rates for peripheral intravenous catheter (PIVC) insertions in children. This systematic review confirms ultrasound
Area of Science:
- Pediatric Emergency Medicine
- Medical Ultrasound Applications
- Clinical Trial Methodology
Background:
- Establishing peripheral intravenous catheters (PIVCs) in pediatric patients is challenging.
- First-attempt success rates for PIVC insertion in children are often suboptimal.
- Ultrasound guidance is a potential method to improve PIVC insertion outcomes.
Purpose of the Study:
- To evaluate the impact of ultrasound on first-attempt PIVC insertion success in pediatric patients.
- To assess overall PIVC insertion success rates with ultrasound guidance.
- To conduct subgroup analyses on factors influencing PIVC success.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials.
- Searched Medline, Embase, CENTRAL, and clinical trial registries.
- Included studies comparing ultrasound-guided PIVC to landmark approach in pediatric patients.
Main Results:
- Nine studies involving 1350 pediatric patients were analyzed.
- Ultrasound significantly improved first-attempt PIVC success in 5 of 8 studies.
- Overall success rates were 78% with ultrasound versus 66% without; pooled OR 3.57 for studies allowing ≥3 attempts.
Conclusions:
- Ultrasound guidance enhances both first-attempt and overall PIVC insertion success rates in children.
- Significant improvements observed in patients with difficult venous access.
- A dynamic, short-axis ultrasound technique by a single operator showed improved success.
Background And Objectives:
Establishing peripheral intravenous catheter (PIVC) access in infants and children is a common procedure but can be technically difficult. The primary objective was to determine the effect ultrasound had on first attempt PIVC insertion success rates in the pediatric population. Secondary objectives included overall success rates and subgroups analyses.
Methods:
A systematic review of articles using Medline, Embase, CENTRAL, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. Randomized trials evaluating ultrasound-guided PIVC insertion against the landmark approach in pediatric patients who reported at least 1 outcome of success rate (first attempt or overall) were included. Methodological quality of the literature was assessed using the Revised Cochrane risk-of-bias tool for randomized trials. A meta-analysis using a random-effects model was performed.
Results:
Nine studies with 1350 patients, from a total of 1033 studies, were included for analysis. Ultrasound showed a statistically significant improvement in PIVC insertion success on first attempt in 5 of 8 studies, with an overall success rate of 78% in the ultrasound group and 66% in the control group. The secondary outcome of overall success was improved by ultrasound in studies that allowed ≥3 attempts (pooled OR 3.57, 95% CI 2.05 to 6.21, P < .001, I2 = 0.0%).
Conclusions:
This systematic review suggested that ultrasound improves pediatric PIVC first pass and overall success rates. Subgroup analysis showed improvement in PIVC success rates for patients with difficult intravenous access and a single operator, dynamic, short-axis ultrasound technique.
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