Intravenous Access In Children Research Articles

Peripherally inserted central venous catheter for pediatric acute leukemia: A retrospective 11-year single-center experience.

Peripherally inserted central catheters (PICCs) are successfully increasingly used in children in onco-hematologic setting. PICC insertion, especially in oncologic patients, can be associated with adverse events (thrombosis, mechanical complications, and infections). Data regarding the use of PICC, as long-term access in pediatric patients with severe hematologic diseases, are still limited. We retrospectively evaluated the safety and efficacy of 196 PICC, inserted in 129 pediatric patients with acute leukemia diagnosed and treated at Pediatric Hematology Unit, Sapienza University of Rome. The 196 PICC analyzed were in situ for a median dwell time of 190 days (range 12-898). In 42 children, PICC was inserted twice and in 10, three times or more due to hematopoietic stem cell transplant, disease recurrence, or PICC-related complications. The overall complication rate was 34%: catheter-related bloodstream infections (CRBSI) occurred in 22% of cases after a median time of 97 days; a catheter-related thrombosis (CRT) in 3.5% and mechanical complications in 9% of cases. Premature removal for complications occurred in 30% of PICC. One death from CRBSI was observed. To our knowledge, this study represents the largest cohort of pediatric patients who have inserted the PICC for acute leukemia. In our experience, PICC was a cheap, safe, and reliable device for long-term intravenous access in children with acute leukemia. This has been possible with the help of dedicated PICC team.

External Validation of the Difficult Intravenous Access (DIVA3) Score as a Clinical Predictive Rule for Identifying Difficult Intravenous Access in Children

External Validation of the Difficult Intravenous Access (DIVA3) Score as a Clinical Predictive Rule for Identifying Difficult Intravenous Access in Children

Prevalence and Factors Affecting Difficult Intravenous Access in Children in Oman: A Cross-sectional Study.

ObjectivesPeripheral intravenous (IV) access is a standard procedure in clinical settings. Nevertheless, previous studies have indicated that difficult peripheral IV access is prevalent in children. This study aimed to determine the prevalence and factors contributing to difficult peripheral IV cannulation in children admitted to a tertiary care hospital in Oman.MethodsThis cross-sectional study was conducted from September to December 2015 at Sultan Qaboos University Hospital in Muscat, Oman. Nurses collected data concerning factors contributing to difficult IV access in children.ResultsA total of 511 children undergoing cannulation during the study period were included in the analysis. Overall, 23.3% of the children experienced two or more cannulation attempts. The study identified three variables associated with successful cannulation in cases of difficult IV access. Visible veins were 2.72-times (95% CI: 1.58–4.68) more likely to be associated with success (p < 0.001), while palpable veins were 2.22-times (95% CI: 1.29–3.83) more likely to be associated with success (p = 0.004). However, scarring from previous IV access attempts was half (95% CI: 0.31–0.77) as likely to be associated with successful cannulation (p = 0.002).ConclusionsWe identified statistically significant variables related to difficult IV cannulation in children, which we used to develop a prediction tool to assess the likelihood of difficult IV access in pediatric patients. Further research is necessary to validate the use of the difficult IV access prediction tool in this population.

Optimal probe position for precordial Doppler ultrasound inchildren.

Precordial Doppler ultrasound technology can be used to confirm correct peripheral intravenous access in children. Changes in precordial Doppler sound from the baseline after injecting normal saline are detected using a correct peripheral intravenous access. However, the location of the precordial Doppler probe has been inconsistent in previous studies. Our study aimed to determine whether the right or left parasternal border is the optimal location for precordial Doppler probe placement. This single-center, prospective interventional study was conducted between July 2021 and January 2022 and included children aged 1-6 years. The Doppler probe was placed under general anesthesia at the most audible site on the right and left parasternal borders of patients. Baseline heartbeat was recorded by the Doppler for 10 s on the right and left parasternal borders. After randomizing the order of the recorded data, two blinded raters separately listened to the data and decided the audibility of the sounds. A total of 77 patients were enrolled in the study. The proportion of the audible baseline heartbeat was significantly higher on the left parasternal borders than on the right by both rater 1 (96.1%, 22.1%, p< 0.001) and rater 2 (96.1%, 27.3%, p< 0.001). Regarding inter-rater reproducibility, Cohen's kappa statistics for the left and right parasternal borders were significant (0.65 and 0.79, both p< 0.001). The baseline heartbeat was more audible on the left parasternal border than on the right parasternal border with acceptably high interrater reproducibility. This is inconsistent with the interpretations of previous reports.

Infrared vein visualization devices for ease of intravenous access in children: hope versus hype.

Peripheral intravenous placement can be difficult in children. Vein finder devices are vascular access devices that delineate veins lying in the subcutaneous tissues to identify potential venipuncture sites. In this narrative review, we highlight the currently available literature on this device to analyse the hope that this device has to offer vs. the unnecessary hype. The search of the databases (Cochrane Library, Google Scholar, and PubMed) was limited to studies on the paediatric population and in English language between 2011 and 2019. Twenty-three relevant articles were found. Most of the articles did not demonstrate amajor impact of these modalities in the general paediatric population. However, they may be beneficial in children with difficult intravenous access. Appro-priate simulator mannequins should be utilised to train healthcare providers in using these vein finder devices.

Intravenous access in children

Abstract Establishing intravenous access in children can be challenging for the healthcare professional and distressing for the patient and their family. Choosing the most appropriate intravenous vascular access is key to improving short-term and long-term care in patients. Children requiring prolonged or repeated intravenous access are at higher risk of venous catheter associated complications, which may result in progressive loss of patent vasculature. Poor planning though multiple, episodic attempts at intravenous access without careful consideration for the type, indication and duration of the venous catheter may limit treatment. Increasingly hospitals have specialist teams, from various disciplines, to insert peripheral and central venous catheters. Correct selection of site and optimal technique may minimize failed attempts at securing intravenous access, improve the experience of paediatric patients and improve care.

Efficacy of Veinlite PEDI in Pediatric Peripheral Intravenous Access: A Randomized Controlled Trial.

A total of 112 pediatric patients were enrolled in the study. Children who presented to the emergency department aged 1 to 10 years old were randomly assigned to the Veinlite PEDI (Veinlite) group or standard of care (SoC) group. The primary outcome measure was first attempt success. Secondary outcome measures were number of intravenous (IV) attempts and time to peripheral intravenous catheter (PIC) placement. A total of 110 patients completed the study: 58 boys and 52 girls. The first attempt success rate was significantly higher in the Veinlite group compared with the SoC group (92.9% vs 72.2%, P < 0.004). In addition, the Veinlite group had a fewer number of attempts compared with the SoC group (1.07 ± 0.54 vs 1.31 ± 0.25, P = 0.04). The Veinlite group resulted in a shorter total time of attempts per patient compared with the SoC group (49.98 ± 18.4 vs 59.68 ± 22.5 P = 0.01). The use of new technology in the Veinlite PEDI (TransLite, Sugar Land, Tex), to assist with peripheral IV access in children, improves the first time success rate for IV access. Improved visualization of veins also reduced the number of attempts and the time required for PIC placement. These results suggest that the new technology of the Veinlite results in better PIC access than Veinlite transilluminaton device with white light.

Use of 8-cm 22G-long peripheral cannulas in pediatric patients.

Medium-term intravenous access in children is normally achieved by means of repeated multiple peripheral intravenous cannula insertions or peripherally inserted central catheters. Long peripheral cannulas might offer an alternative to these devices in children. Our aim was to clarify whether long peripheral cannulas provide reliable medium-term intravenous access avoiding the need for multiple peripheral intravenous cannulations or peripherally inserted central catheter insertion in children undergoing surgery. Following ethical approval, we prospectively collected data in children requiring medium-term intravenous access. The 22G-8-cm-long peripheral cannulas were inserted with a Seldinger technique in a peripheral vein. Position was checked by flushing and aspirating the catheter. Results are reported as mean ± standard deviation. A total of 18 children were included. Indications for medium-term intravenous therapy included perforated appendicitis (n = 14), infected central venous port (n = 2), fungal infection (n = 1) and septic arthritis (n = 1). In all, 15 (83%) patients underwent the procedure under general anaesthetic. The procedure failed in an 8-year-old patient. Insertion time was 8 ± 3.7 min. Age at insertion was 6.3 ± 4.9 years. Duration of intravenous therapy was 6.4 ± 5.1 days. About 13 (76%) patients completed the treatment with no complications. Three (17%) lines occluded by day 3 needed removal; one (7%) line needed removal on day 3 because of redness/pain noted around the insertion site. Long peripheral cannulas represent a valid option for medium-term intravenous access in children undergoing surgery. Majority of patients will be successfully treated with one long peripheral cannula for the duration of their treatment without the need for further cannulation.

Difficulties Related to Peripheral Intravenous Access in Children in an Emergency Room.

This prospective study examined the characteristics of children admitted to a pediatric emergency department and the factors that influenced the successful establishment of peripheral intravenous (IV) access. Descriptive and correlational analysis was completed using a convenience sample of 89 patients. Peripheral IV access was successful in 95.7% of the children, and the first attempt at insertion was successful in 53% of the procedures. Factors influencing the success of peripheral IV access were the patient's gender, skin color, presence of difficult-to-see veins, small veins, presence of fever, and a lack of palpable veins.

Pain and Stress Response during Intravenous Access in Children with Congenital Adrenal Hyperplasia: Effects of EMLA and Nitrous Oxide Treatment.

Background Congenital adrenal hyperplasia (CAH) is an endocrine condition that requires regularly blood samples for optimal treatment. The management of CAH in children is complex when intravenous access is one of the most stressful procedures for children. The purpose of this pilot study was to investigate the effects of nitrous oxide inhalation (N2O) in combination with cutaneous application of local anesthetics (EMLA) for improving intravenous access in children with CAH. Method Ten children (7–14 years) were studied. The children received two intravenous procedures: one with EMLA and one with EMLA + N2O. The order of priority was randomized. The outcomes were the children's pain experience (0–10) and an evaluation of satisfaction (1–5) after the procedure. Heart rate, blood pressure, saturation, and analyses of 17-hydroxyprogesterone (17-OHP), norepinephrine, and glucose were analyzed. Results Higher pain scores, heart rate, and glucose levels were reported after EMLA, compared to EMLA + N2O, but 17-OHP levels remained unchanged. The children's satisfaction with the intravenous procedure was more positive for EMLA + N2O. Conclusions EMLA + N2O offers the possibility of improving the intravenous procedure for anxious children with CAH. Although the quality of care was better with N2O treatment, it was not possible to demonstrate that this is a prerequisite for valid 17-OHP measurements.

The Efficacy of Near-Infrared Devices in Facilitating Peripheral Intravenous Access in Children: A Systematic Review and Subgroup Meta-Analysis

Peripheral intravenous access is a common and invasive procedure that is performed in pediatric clinical settings. Children often have difficult intravenous-access problems that may not only increase staff stress but also affect the timeliness of immediate treatments. To determine the efficacy of near-infrared devices in facilitating peripheral intravenous access in children, using a systematic review and meta-analysis. Six databases, namely the Index to Taiwan Periodical Literature System, Airiti Library, CINAHL, Cochrane Library, PubMed/MEDLINE, and ProQuest were searched for related articles that were published between the earliest year available and February 2017. The search was limited to studies on populations of children that used either a randomized controlled trial or controlled clinical trial approach and used the key words "near-infrared devices" AND "peripheral intravenous access." The 12 articles that met these criteria were included in the analysis. The Cochrane Collaboration bias assessment tool was used to assess the methodological quality. In addition, RevMan 5.3.5 software was used to conduct the meta-analysis. The near-infrared devices did not significantly improve the first-attempt success rate, number of attempts, or the procedural time of peripheral intravenous access in children. However, the subgroup analysis of difficult intravenous-access factors revealed a significant improvement in the first-attempt success rate of children with difficult intravenous access scores (OR = 1.83, p = .03). Near-infrared devices may improve the first-attempt success rate in children with difficult intravenous access by allowing healthcare professionals to visualize the peripheral veins. Therefore, we suggest that the difficult intravenous-access score be used as a screening tool to suggest when to apply near-infrared devices to children with difficult peripheral intravenous access in order to maximize efficacy of treatment.

The use of 8-cm 22G Seldinger catheters for intravenous access in children with cystic fibrosis.

Long intravenous catheters are an effective and economical choice of vascular access for intravenous antibiotic therapy in children with cystic fibrosis (CF). This prospective audit assesses the use of Vygon Leaderflex 22G × 8 cm catheters in an Australian tertiary centre. Key outcomes included catheter lifespan, ability to complete antibiotic therapy and complication rates. All paediatric patients admitted with infective exacerbations of CF lung disease for 18 months between 2012 and 2013 were prospectively included. Data were analysed using t-tests and Fisher exact test. A total of 40 successful catheter insertions for 20 patients during 32 admissions were identified. The mean duration of the catheters was 10.08 days (median 9.5, SD=5.0). Of the 32 admissions, antibiotic therapy was completed with long catheters in 78% of cases (n=25) and with a single catheter in 48% (n=19). Rates of local complications were high, but there were no serious adverse outcomes. Although limited by a small sample size, the results from this study are promising and suggest that 8 cm long catheters are a safe, effective and economical alternative to peripherally inserted central catheters (PICCs) in treating pulmonary exacerbations in children with CF.

A Systematic Review and Meta-analysis of New Interventions for Peripheral Intravenous Cannulation of Children

Establishing intravenous access in children is often challenging for health professionals. Multiple attempts at peripheral intravenous cannulation (PIVC) cause increased pain and delayed delivery of therapy. Our objective was to synthesize and evaluate the best evidence for novel interventions designed to improve pediatric PIVC. We searched for published and unpublished studies using MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, Web of Science, ClinicalTrials.gov, and Google.ca. We included studies for meta-analysis if they were randomized, evaluated an intervention other than ultrasound, and reported on 1 of 3 primary outcome measures: success or failure of PIVC, number of attempts to successful cannulation, and procedure time. Two blinded reviewers assessed studies for eligibility and applied a data extraction form to those included. Study quality was assessed using the Cochrane Risk of Bias Tool. Seven studies met the inclusion criteria. Randomized controlled trials (RCTs) of 3 different interventions were identified. A meta-analysis of 3 RCTs found that use of a transilluminator was associated with a decreased risk of first-attempt PIVC failure (risk ratio, 0.66; confidence interval, 0.41-1.06). Meta-analysis of 3 other RCTs found that near-infrared light devices do not impact the risk of first-attempt PIVC failure (risk ratio, 0.99; confidence interval, 0.74-1.33). Near-infrared light devices might be efficacious in selected subpopulations, but the available evidence does not support an overall benefit in the pediatric population. Transilluminators modestly improve pediatric PIVC, but the clinical significance of this benefit is questionable. Nitroglycerin ointments may increase the risk of PIVC failure and are associated with adverse effects.

New Biomedical Devices That Use Near-Infrared Technology to Assist With Phlebotomy and Vascular Access

Obtaining intravenous access in children is often challenging. Devices using the novel technology of near-infrared imaging have been developed and marketed to facilitate intravenous catheter placement and phlebotomy. We review the technology of near-infrared imaging and the evidence for its use in the pediatric emergency population.

The use of 50% nitrous oxide improves successful intravenous access in obese and growth-limited children in an outpatient setting

Commentary on: Ekbom K, Kalman S, Jakobsson J, et al. Efficient intravenous access without distress: a double-blind randomized study of midazolam and nitrous oxide in children and adolescents. Arch Pediatr...

General anesthesia without intravenous access in children – a survey of current practice among members of the APAGBI and UK regional representatives of the APAGBI and the AAGBI

The establishment of intravenous (IV) access should be considered for all adults and children undergoing general anesthesia. Inhalational induction prior to the establishment of IV access remains a popular technique in pediatric practice, and most practitioners will subsequently obtain IV access at the earliest opportunity. Previous surveys have indicated that some anesthetists may elect to omit IV access for the duration of anesthesia and surgery; however, the extent of this practice is unclear. A survey of pediatric anesthetists (members of the APAGBI and regional representatives of both the APAGBI and the AAGBI) was conducted to determine the prevalence of anesthesia without IV access in children, together with the circumstances in which this would be considered by practitioners. A web-based survey was distributed via email to members of the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) and regional representatives of both the APAGBI and the Association of Anesthetists of Great Britain and Ireland (AAGBI). In total, 1419 invitations to complete the survey were sent. Seven hundred and twenty seven completed surveys were returned, indicating a response rate of 51%. Twenty-eight respondents reported that they did not anesthetize children age <16 years. Of the remaining 699 respondents, 295 (42%) described circumstances where intravenous access was omitted during general anesthesia. The vast majority (84.7%) indicated that this was a rare occurrence. Only 44 (6.3%) respondents indicated they would always or usually undertake procedures under general anesthesia in children without IV access. Respondents suggested that short procedures, including dental extractions and myringotomy, were circumstances in which this practice was acceptable. The majority of respondents to this survey reported that they would usually establish IV access in children undergoing general anesthesia except in specific circumstances.

An evaluation of peripherally inserted central venous catheters for children with cancer requiring long-term venous access

Long-term venous access is essential when treating malignant diseases. We reviewed our experience with peripherally inserted central venous catheters (PICC) in children suffering from various malignancies with regard to catheter life, reasons for removal, and complications. Ninety-three PICCs were inserted in 78 children. Median catheter life was 162days (range 6-575days) with a total of 16,266 catheter days. Seventy-five PICCs (80.6%) had been placed until the elective removal or patients' death, whereas 18 PICCs (19.4%) were removed due to PICC-related complications; a rate of 1.11 per 1,000 catheter days. Complications requiring removal of PICCs included infection (n=12), occlusion (n=3), dislodgement (n=2), and phlebitis (n=1) with rates of 0.74, 0.18, 0.12 and 0.06 per 1,000 catheter days, respectively. We conclude that PICC provides reliable long-term intravenous access in children suffering from malignancies.

Peripherally inserted central venous catheters are a good option for prolonged venous access in children with cancer

A long term venous access device is essential in children with malignancies for the safe administration of medication and to avoid repeated painful venipunctures. The advantage of peripherally inserted central venous catheters (PICC) over conventional central venous catheter (CVC) is easy bedside insertion without need for general anesthesia and theatre time. The purpose of this study was to evaluate our experience with PICCs particularly with regard to catheter life, reason for removal and complications in children suffering from various malignancies. A retrospective analysis of all PICCs inserted in children with cancer was done with regard to the demographic data, catheter life, reason for removal, and complications. The latter two were evaluated in association with patient age, catheter days, and year of insertion. Of 127 catheters inserted in 127 children, median catheter life was 161 days with a total of 18,955 catheter days (for 124 patients, 3 lost to follow-up). Elective removal occurred in 63/101 (62.4%) PICCs and removal due to complications resulted in a complication rate of 2.41 per 1,000 catheter days. The common reasons for catheter removal were suspected infection, breakage/leakage, dislodgement, phlebitis, and occlusion with rates of 1.27, 0.57, 0.31, 0.06, and 0.06 per 1,000 catheter days, respectively. We found PICC to be a convenient, cheap, safe, and reliable device for long term intravenous access in children with malignancies. This was possible with the help of dedicated catheter care nurses.

Prehospital intravenous access in children

To examine the ability of a unified metropolitan paramedic system to provide IV access in children when indicated. Retrospective, descriptive clinical study. A large metropolitan area in Canada. Five hundred thirteen children from birth through 18 years of age who were transported by paramedics. Indications for IV access, rates of successful placement, and time to achieve access were determined. Criteria for IV line placement were developed and applied retrospectively. Intravenous line attempts were made in 300 children (58%). Intravenous line placement was obtained in 253 (84% of the patients attempted). One hundred fifty-nine children met criteria for IV placement in the field. Six of these children were clinically dead and received no on-scene resuscitative efforts and were excluded from data analysis. Of the remaining 153 children who met criteria, 122 (80%) had IV attempts made, and 104 (68%) had an IV line placed successfully. For children who met the criteria for IV placement, a significantly smaller proportion of children younger than 6 years had an IV line placed successfully (49%) compared with children 6 years or older (75%) (P < .005). Two subgroups of children who met criteria were examined: children with vital signs absent and trauma patients. For those who belonged to the subgroup with vital signs absent, a significantly smaller proportion of children younger than 6 years had an IV line placed successfully (43%) compared with children 6 years or older (92%) (P < .01) Eighty-four percent of patients who met criteria and who had one IV line successfully placed received only one IV line attempt, and 87% of patients who met criteria and who had two IV lines placed successfully received only two attempts. Although paramedics had an 84% success rate at establishing IV lines in children in the field, half the children younger than 6 years who required intravascular access did not receive an IV line in the prehospital setting. Multiple IV line attempts should be discouraged because additional attempts yield little benefit and may prolong transport times.