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Factors Affecting Peripheral Intravenous Catheter Placement During Pediatric Trauma Resuscitation
Emily C Alberto1, Angela Mastrianni2, Travis M Sullivan1
1Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia.
Insights
Younger children experienced more difficulty with peripheral intravenous (PIV) catheter placement, leading to longer procedure times and abandoned attempts. Early consideration of alternative access methods is crucial for timely resuscitation in pediatric trauma patients.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Resuscitation
- Vascular Access
Background:
- Peripheral intravenous (PIV) catheter placement is essential for resuscitation but challenging in pediatric patients.
- Identifying factors for difficult PIV access can optimize timely intravenous access strategies.
Purpose of the Study:
- To identify factors associated with difficult peripheral intravenous (PIV) catheter placement in injured children and adolescents.
- To analyze the impact of patient characteristics and injury severity on PIV placement success and time.
Main Methods:
- Retrospective video-based review of 154 injured children and adolescents undergoing PIV placement.
- Analysis of demographic, physiological, injury, and resuscitation data.
- Multivariable regression to determine factors associated with PIV placement success and abandonment.
Main Results:
- 90.3% of PIV placements were successful.
- Younger age was associated with increased time to PIV placement and higher rates of abandonment.
- Non-blunt injuries and pre-existing access were linked to abandoned PIV attempts.
Conclusions:
- Younger pediatric patients face greater challenges with PIV placement, impacting resuscitation timelines.
- Strategies to enhance PIV success and alternative access routes are needed for younger children to prevent treatment delays.
Introduction:
Intravenous access is required for resuscitation of injured patients but may be delayed in children because of challenges associated with peripheral intravenous (PIV) catheter placement. Early identification of factors predisposing patients to difficult PIV placement can assist in deciding strategies for timely intravenous access.
Methods:
We conducted a retrospective, video-based review of injured children and adolescents treated between April 2018 and May 2019. Patient demographic, physiological, injury, and resuscitation characteristics were obtained from the patient record, including age, race, weight, injury type, Injury Severity Score, initial systolic blood pressure, initial Glasgow Coma Score, intubation status, activation level, and presence of prearrival notification. Video review was used to determine the time to PIV placement, the number of attempts required, the purpose for additional access, and the reason for abandonment of PIV placement. Multivariable regressions were used to determine factors associated with successful placement.
Results:
During the study period, 154 consented patients underwent attempts at PIV placement in the trauma bay. Placement was successful in 139 (90.3%) patients. Older patients (OR [odds ratio]: 0.9, 95% confidence interval [CI]: 0.9, 0.9) and patients who required the highest level activation response (OR: 0.0, 95% CI: 0.0, 0.3) were less likely to have an attempt at PIV placement abandoned. Children with nonblunt injuries (OR: 11.6, 95% CI: 1.3, 119.2) and pre-existing access (OR: 39.6, 95% CI: 7.0, 350.6) were more likely to have an attempt at PIV placement abandoned. Among patients with successful PIV placement, the time required for establishing PIV access was faster as age increased (-0.5 s, 95% CI: -1.1, -0.0).
Conclusions:
Younger age was associated with abandonment of PIV attempts and, when successful, increased time to placement. Strategies to improve successful PIV placement and alternate routes of access should be considered early to prevent treatment delays in younger children.
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