Technical Challenges When Performing Ultrasound-Guided Peripheral Intravenous Placement in Children

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.