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Technical Challenges When Performing Ultrasound-Guided Peripheral Intravenous Placement in Children
Maria Moustaqim-Barrette1,2, Lauren Riehm1, Dimitri Parra3
1Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Canada.
Insights
Ultrasound (US) guidance improves peripheral intravenous (PIV) placement in children, especially those with difficult access. This review details common challenges and strategies for successful US-guided PIV insertion in pediatric patients.
Area of Science:
- Pediatric Medicine
- Medical Imaging
- Interventional Procedures
Background:
- Ultrasound (US) guidance is increasingly vital for peripheral intravenous (PIV) catheterization in children.
- It serves as a primary method or rescue technique for patients with difficult intravenous access (DiVA).
- The widespread availability of US technology facilitates its use by various clinicians.
Purpose of the Study:
- To review common technical challenges encountered during US-guided PIV placement in pediatric patients.
- To outline practical strategies for improving cannulation success rates.
- To address specific considerations for special pediatric populations.
Main Methods:
- Literature review summarizing existing research on US-guided PIV placement in children.
- Identification and categorization of common technical difficulties.
- Compilation of strategies to overcome these challenges.
Main Results:
- US guidance significantly benefits PIV placement in children with DiVA.
- Novice and trainee proceduralists may face specific technical hurdles.
- Effective strategies exist to mitigate common challenges and enhance success.
Conclusions:
- Mastering US-guided PIV placement requires understanding and overcoming technical challenges.
- Specific patient populations (e.g., neonates, burn patients) require tailored approaches.
- This review provides a practical guide for improving pediatric PIV access using US guidance.
Abstract:
Ultrasound (US) guidance has become an essential skill for peripheral intravenous (PIV) placement in children. It may be used as a primary approach or as a rescue technique after failed attempts, particularly in children with difficult intravenous access (DiVA). An increasing amount of literature shows the benefit of using US guidance for PIV placement in children with DiVA. With more consistent availability of US machines across many institutions, their use for PIV placement is becoming commonplace, with several types of clinicians performing the procedure. Novice proceduralists and those in training may encounter technical challenges that may impede successful PIV cannulation. Having strategies to avoid, troubleshoot, and overcome technical challenges is essential for improving the technique of US guidance for PIV access. The purpose of this review was to summarize the literature around the most common technical challenges that arise when performing US-guided PIV placement in children and practical strategies that may improve cannulation success. We also highlight US-guided PIV placement considerations specific to special populations, including premature neonates, pediatric burns, epidermolysis bullosa, and those receiving bleomycin sclerotherapy.
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