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Ultrasound guidance improves first-attempt success in IV access in children

By 13th September 2019No Comments

The need to place an intravenous line is a common but challenging requirement for pediatric health care providers. Previous research has shown first-attempt success rates for pediatric intravenous line access of approximately 75%, although some children with difficult intravenous access may require multiple attempts. Difficulty in obtaining intravenous line access may result in diagnostic and treatment delays, in addition to increased pain and anxiety for the patient and family. If intravenous line access cannot be obtained, more invasive procedures, including central or intraosseous line placement, may be required.

A recent report (Vinograd AM et al Ultrasonographic Guidance to Improve First-Attempt Success in Children With Predicted Difficult Intravenous Access in the Emergency Department: A Randomized Controlled Trial. Ann Emerg Med. 2019 Jul;7419-27. doi: 10.1016/j.annemergmed.2019.02.019) has shown that when caregivers used ultrasound to guide placement of intravenous (IV) lines in children with presumed difficult access, they had higher success rates on their first attempt.

The researchers from Children’s Hospital of Philadelphia (CHOP) report that this technique reduces the number of needle sticks in their young patients. “The need to place an intravenous line is a common but challenging requirement for pediatric healthcare providers,” said Dr. Alexandra M. Vinograd, an emergency medicine physician at CHOP and the lead investigator of this study. “Our research shows that both the children and their parents are happier with ultrasound-guided line insertion.

The researchers prospectively enrolled 167 patients identified as having difficult IV access and who were randomized to receive either traditional IV line or care from a multidisciplinary team trained to place ultrasound-guided IV lines on the first attempt. The children were divided into two groups, age zero to three years old, and over age three.

First-attempt success was higher in the ultrasound-guided IV line placement group (85.4 percent) compared to the traditional intravenous line group (45.8 percent). When asked to score their satisfaction with the IV line placement, parents favored the ultrasonically guided placement over the traditional method.

In our study, ultrasound-guided intravenous lines remained in place longer than traditional insertion, without an increase in complications,” said Dr. Joseph J. Zorc, senior author of the study. “These results may be used to update guidelines for intravenous line access in children in an effort to limit the number of needle sticks they experience.

Both nurses and physicians had high rates of first-attempt success. The high rate of nurse success led to a training program in CHOP’s Emergency Department that broadly trains nurses in ultrasound-guided IV line placement. “Ultrasound-guided access is now standard procedure for patients with presumed difficult intravenous access,” added Vinograd.

doi: 10.1016/j.annemergmed.2019.02.019