Venous Response to Tourniquet Pressure in Children: Implications for Peripheral Intravenous Access

To investigate the impact of different tourniquet pressures and application durations on venous diameter and compliance in children, in order to optimise conditions for peripheral intravenous catheter insertion.

This non-randomised clinical study included 21 healthy children aged 6-10 years. Vein diameter was measured using ultrasound. The force required to fully compress the vein was measured with a pressure-sensing device. Tourniquet pressures of 20-100 mmHg were applied for 60 s, with measurements every 10 s. Data were analyzed using non-parametric methods to assess changes over time and correlations between variables.

Vein diameter changed significantly over time at all applied pressures. All tourniquet pressures showed a significant reduction in venous compliance. Substantial interindividual variation was observed in the pressure and timing that yielded optimal changes in vein diameter and compliance. Vein diameters ranged from 1 to 5 mm, with no consistent correlation with age or body weight.

Paediatric tourniquet application markedly increases venous diameter and reduces venous compliance. The substantial interindividual variation in these responses motivates individualised rather than universal approaches. Future research should aim to develop practical techniques to assess and optimise venous conditions, thereby improving the success rate of paediatric intravenous catheter insertion.