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Characterization of the Difficult Peripheral IV in the Perioperative Setting: A Prospective, Observational Study of
Grant Heydinger1,2, Shabana Z Shafy1, Colin O'Connor1
1Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
Insights
Difficult intravenous access (DIVA) in pediatric patients is often linked to younger age, higher ASA classification, and a history of previous difficult IV placements. Approximately 9% of children required multiple attempts for IV access during anesthetic care.
Area of Science:
- Anesthesiology
- Pediatric Care
- Vascular Access
Background:
- Defining difficult intravenous access (DIVA) in pediatric patients varies.
- A prospective study evaluated factors contributing to DIVA in infants and children undergoing anesthetic care.
Purpose of the Study:
- To identify patient characteristics and factors associated with difficult peripheral intravenous (PIV) cannulation in pediatric patients.
- To establish predictors for requiring multiple attempts for PIV placement.
Main Methods:
- A prospective, observational study included 1002 pediatric patients (0-18 years) undergoing elective procedures.
- Providers used a visual analogue scale (VAS) to predict and assess PIV placement difficulty.
- DIVA was defined as three or more PIV attempts; patient data including age, BMI, ASA classification, and PIV history were collected.
Main Results:
- 91% of patients achieved PIV access within two attempts; 9% met the definition of DIVA.
- Younger age (under 3 years), higher American Society of Anesthesiologists (ASA) physical classification (ASA II), and a prior history of difficult PIV placement were significant predictors of DIVA.
- Body mass index (BMI), race, and gender did not independently predict DIVA.
Conclusions:
- Approximately 9% of pediatric patients experienced DIVA, requiring three or more IV attempts.
- Younger age, higher ASA physical classification, and a history of difficult PIV placement are key factors associated with DIVA in children.
- These findings aid in anticipating and managing DIVA in pediatric anesthesia.
Background:
Various criteria exist for defining difficult intravenous access (DIVA) in infants and children. The current study evaluated the factors associated with DIVA in a prospective cohort of over 1000 infants and children presenting for anesthetic care.
Methods:
This was a prospective, observational study of patients aged 0 to 18 years undergoing elective surgical or radiologic procedures under general anesthesia. Prior to the initial attempt at peripheral intravenous (PIV) cannulation, the anticipated difficulty of PIV catheter placement was determined by the provider using a visual analogue scale (VAS) from 1 to 10. The number of attempts was recorded as well as the time required to achieve PIV access. DIVA was defined as requiring three or more attempts. After successful cannulation, the actual difficulty of the PIV placement was assessed by the provider and recorded using the same VAS. Patient characteristics, including age, race, body mass index (BMI), American Society of Anesthesiologists (ASA) physical classification, and history of difficult PIV placement, were evaluated as covariates.
Results:
In our cohort of 1002 pediatric patients, 78% of patients were successfully cannulated in a single attempt and 91% of patients were successfully cannulated in two or fewer attempts. Factors associated with requiring three or more PIV attempts included younger age (OR 8.73; 95% CI: 3.38, 22.6 for age <1 year and OR 4.93; 95% CI: 2.05, 11.8 for age 1-3 years), higher ASA physical classification (OR 1.95; 95% CI: 1.10, 3.46 for ASA II), and prior history of difficult PIV placement (OR 3.46; 95% CI: 1.70, 7.08). BMI, racial category or gender were not independent predictors of DIVA.
Conclusion:
We found that approximately 9% of patients required three or more attempts at IV placement in the operating room. Patients that required multiple PIV attempts were more likely to be younger, have a higher ASA classification or a history of difficult PIV placement.
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