Single Attempt Research Articles

Comparative Study between Laparoscopic Common Bile Duct Exploration plus Cholecystectomy versus Endoscopic Retrograde Cholangiopancreatography plus Cholecystectomy for Cholecysto-Choledocholithiasis

Introduction: The management of concomitant gallbladder and common bile duct stones have been debated between both endoscopic and laparoscopic techniques.
 Objective: The objective of this study is to compare the efficacy, safety, cost and surgical outcomes of laparoscopic common bile duct exploration plus cholecystectomy and endoscopic retrograde cholangiopancreatography plus cholecystectomy.
 Methodology: This is a comparative interventional study carried out among 62 patients with concomitant gallstones and common bile duct stones. The study population was divided into two groups by simple randomized sampling technique (lottery technique). Group A underwent laparoscopic common bile duct exploration followed by laparoscopic cholecystectomy in one stage (single-staged management). Group B underwent endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy in second hospital visit (two-staged management).
 Results: Complete clearance of the stone with a single attempt was achieved in Group A compared to Group B as 8 patients had gone for a second attempt in group B. Post operative pancreatitis was higher i.e. 24(77.41%) in Group B with statically significance (p value <0.005). Other complications like bleeding i.e. 29(93.54% in A and 26(83.87%) in B group, perforation was also noted during the study period that includes 29(93.54%) in B group. The mean operative time was longer in Group A i.e. 130.2 ± 41.5 minutes while in Group B was 78.5± 10.2 minutes which was statistically significant (p <0.001).The cost of procedure was higher for patients undergoing two-staged management. 
 Conclusion: The complete clearance of the stone with a single attempt was achieved in Group A compared to Group B where 8 patients had a second attempt. Also incidence of pancreatitis was higher in Group B and statically significant. Other complications like bleeding perforation was also noted during the study period in B group. The mean operative time was longer in Group A which was statistically significant. However, for those patients with concomitant gallbladder and common bile duct stones, single-staged management consisting of laparoscopic common bile duct exploration and laparoscopic cholecystectomy could be the preferred method of treatment where the expertise and facilities are available.

Comparative evaluation of subclavian vein catheterization by supraclavicular and infraclavicular approach

The present study was conducted in Department of Anaesthesia, Sardar Patel Medical College and PBM Hospital, Bikaner, with the aim of comparative evaluation of subclavian vein catheterization by supraclavicular and infraclavicular approach. There are three common routes of central venous catheterization i.e. subclavian, internal jugular and the femoral. Hence in our study we have done a comparative evaluation of supraclavicular and infraclavicular approach for SCV catheterization with primary objective of successful catheterization of SCV using anatomical landmark technique and secondary objective of first attempt success rate, time taken for cannulation and also record the incidence of complications related to either approach. In our study, 60 patients enrolled were randomly divided into two groups of 30 patients each. In Group A Infraclavicular SCV catheterization and in Group B Supraclavicular catheterisation was performed using anatomical landmark approach. Successful catheterization, first attempt success rate, time taken for venous access and catheterization, catheter malfunction or any other complication were recorded. In group A (IC) Maximum 63.33% were inserted in single attempt whereas minimum 10% required 3 or more attempts while in group B (IC) maximum 93.33% were inserted in single attempt whereas minimum 3.33% needed 3 or more attempts, and the difference was found statistically significant. Overall successful catheterization was 90% in Group A and 96% in Group B while 93 % when combined for both groups. Mean time taken for insertion was observed more (6.67 ± 1.44 min.) in group A whereas less (4.47 ± 1.01min.) in group B, and the difference was found statistically highly significant. We conclude that SC approach of SCV catheterization is better as comparable to IC approach in terms of landmarks accessibility, success rate, time taken and rate of complications.

Locked Posterior Shoulder Dislocation with Impression Fracture Treated All Arthroscopically With the Use of an Allograft Bone Block a Case Report

Locked posterior shoulder dislocations are uncommon and poses many difficulties in diagnosis. They are often overlooked during initial examination and delayed diagnosis adversely affects healing process. Apart from many open treatment options there are reports of single attempts to treat such cases arthroscopically. We present an original case of a posterior locked dislocation of the shoulder joint with a fracture of the lesser tuberosity followed by reverse Hill-Sachs fracture, treated in a novel fashion all-arthroscopically with the use of allogenic bone graft. According to Constant Shoulder Score that tries to asses functional and subjective performance of the shoulder joint before the operation and after 12 months, we achieved a leap from 11% to 84%. The patient restored almost full range of motion and painless movement in activi-ties of daily life as well as during sports. The use of an arthroscopy reduces the invasiveness of the procedure, improves visualization of the joint and allows augmentation of the bone loss without performing an open approach. We believe that this is A promising method of treatment for selected cases of locked posterior shoulder dislocation.

What is the Fallacy of Approximation?

Many philosophers appeal to the “fallacy of approximation”, or “problem of second best”. However, despite the pervasiveness of such appeals, there has been only a single attempt to provide a systematic account of what the fallacy is. We identify the shortcomings of this account and propose a better one in its place. Our account not only captures all the contexts in which approximation-based reasoning occurs but also systematically explains the several different ways in which it can be in error.

Clinical Outcomes of a Non-Compliant Balloon Dilatation Catheter: MOZEC™ NC Study

The present study sought to assess the clinical outcomes of the Mozec™ Non-compliant (NC) Rx PTCA balloon dilatation catheter (BDC) (Meril Life Sciences Pvt. Ltd., Vapi, India) for dilatation of coronary lesions. This was a post-marketing, single-centre, single-arm, retrospective study. In total, 57 patients who had undergone post-dilatation with the Mozec™ NC Rx PTCA balloon dilatation catheter were evaluated. The primary endpoint was procedural success defined as (i) successful delivery of the investigational device to and across the target lesion; (ii) successful inflation, deflation, and withdrawal of the investigational device; (iii) absence of vessel perforation, flow-limiting vessel dissection, increase in thrombolysis in myocardial infarction (TIMI) flow from baseline, clinically significant arrhythmia requiring medical treatment; and (iv) achievement of final TIMI flow grade 3 after percutaneous coronary intervention of the target lesion after single or multiple attempts to cross the target lesion. Procedural success was achieved in 57 (100%) patients. There were no incidences of major adverse cardiac events (MACE)/target lesion failure (TLF). Mozec™ NC Rx PTCA balloon dilatation catheter has demonstrated favourable outcomes for the dilatation of routine and complex coronary lesions in a small cohort, as evidenced by its 100% procedural success rate and absence of MACE.

The Synergistic Effects of Neuroticism and Extraversion on Suicidal Ideation, Single Attempts, and Multiple Attempts in an Inpatient Sample.

The current study sought to investigate the differential risk/protective factors of neuroticism and extraversion among individuals with only suicide ideation, those with a single suicide attempt, and those with multiple attempts. We hypothesized that extraversion would moderate the relation between neuroticism and suicide attempts (single and multiple) but not ideation. Patients in a private facility (N = 3343) completed measures assessing suicide history and general personality traits. Four moderation analyses were conducted with extraversion moderating the relationship between neuroticism and suicide ideation, single attempt (compared to zero attempts), and multiple attempts (compared to zero attempts and to single attempts). Extraversion moderated neuroticism only when comparing individuals with multiple suicide attempts to those with no attempts. Individuals who were low in both neuroticism and extraversion had higher levels of attempts than individuals with low neuroticism and high extraversion, highlighting the importance of considering biological predispositions as risk factors for suicide.

Arterial blood gas tensions - Effect of storage time and temperature

Introduction: Arterial and venous blood gas analysis provide vital information on pH, oxygenation, ventilatory and acid-base status that guide clinician interventions. Factors such as syringe material, sampling technique, type of anticoagulant, storage time and temperature, and analysis may influence the accuracy of results. Aim: To determine the effect of storage time and temperature on blood gas analysis. Method: Nine 1-ml samples of arterial blood were collected by convenient sampling method involving 25 subjects in a single attempt from an in-dwelling arterial line. Four samples were stored in separate ice bags and four at room temperature. One sample was analysed immediately (‘reference’). One sample from each storage group was analysed at 15-min intervals for 60-min. The agreement of the ‘ureference’ value with values of samples taken at 15-, 30-, 45- and 60-min were determined using Lin’s concordance correlation and Bland and Altman’s 95% limits of agreement (LOA). Results: The rate of decay of pH and PaCO2 values over time were similar for samples stored at room temperature and ice. The average difference (95% LOA) in PaO2 on samples stored at room temperature at 15, 30, 45 and 60 min when compared with baseline were 1.80 (-18 to 21.7), 3.84 (-20.5 to 28.2), 3.40 (-18.8 to 25.6) and 4.36 (-17.5 to 26.2) respectively. The decay in PaO2 was less pronounced in samples stored in ice with differences of -2.04 (-18.3 to 14.2), -2.64 (-14.2 to 9.0), -3.08 (-20.0 to 13.5) and -2.40 (-12.2 to 7.4) at 15, 30, 45 and 60 min respectively. Conclusion: PaO2 values reduce with time. The changes are more pronounced when samples are stored in room temperature than in ice. The wide LOA would imply that blood gas samples should, as far as possible, be processed immediately.

Factors associated with single and multiple suicide attempts in adolescent school children in Morocco: A national cross-sectional survey

The study aimed to assess factors associated with multiple suicide attempts (MSA) in adolescents with a history of suicide attempts in Morocco. National cross-sectional data from the Global School-Based Student Health Survey (GSHS) in Morocco in 2016 were analysed. Students who reported to have a history of past 12-month suicide attempts were included in the final sample (n = 931). In multiple logistic regression, students with MSA were compared with students with a single suicide attempt (SSA). Results indicated that among the subsample of school adolescents (median age = 15 years), 55.8% had attempted suicide once, and 44.2% multiple times in the past 12 months. Compared to students who attempted suicide once, students with MSA more often had anxiety-induced sleep disturbance and were more frequently bullied. Compared to participants without psychosocial distress, students with three or more psychosocial distress factors had higher odds of MSA. Further, compared to students without health risk behaviours, students with three or more health risk behaviours had a higher odd of MSA. Psychosocial distress (anxiety-induced sleep disturbance and frequently being bullied) and multiple health risk behaviours increased the odds of MSA, suggesting the potential relevance of these variables in identifying multiple suicide attempters among adolescents in Morocco.

Concordance between the Columbia-Suicide Severity Rating Scale and Beck Scale for Suicide Ideation in assessing suicide behaviour in young adults with schizophrenia spectrum disorders

The Columbia Suicide Severity Rating Scale (C–SSRS) is considered the gold standard for collecting information on suicidal ideation and behavior by the Food and Drug Administration (FDA) of the United States. To determine the accuracy of the C-SSRS compared to the Beck Scale for Suicidal Ideation (BSS) for collecting suicide attempt history in the schizophrenia population, 202 participants aged 18–40 with schizophrenia spectrum disorders were administered the C-SSRS, followed by the BSS. Medical charts were reviewed to confirm the lifetime history of actual suicide attempts. The BSS had an 83.5% accuracy in reporting single suicide attempts and 81.7% for multiple suicide attempts; while the C-SSRS had 84.1% and 83.9% accuracy respectively. This difference was not statistically significant (p = 0.849). Both the BSS and C-SSRS demonstrated high sensitivity and specificity in collecting suicide attempt history for young patients with psychosis, with no significant differences. Future investigators may choose the scale that is best suited to the level of detail required.

Analysing the linkage between total factor productivity and tourism growth in Latin American countries

PurposeThe study aims to investigate the nexus between total factor productivity and tourism growth in Latin American countries for time series data from 1995 to 2017.Design/methodology/approachUsing the extension of the Granger noncausality test in the nonlinear time-varying of Ajmi et al. (2015), the study points out the interconnectedness between the variables during the period.FindingsThe study found nonlinear causality between the variables. Particularly, studying the conclusions for the time-varying Granger causality fashion, it can be noticed that the one-way causality from total factor productivity to tourism growth is obtained for Argentina, Bolivia, Brazil, Uruguay and Venezuela, while the vice versa is confirmed for Chile, Ecuador and Nicaragua. Lastly, the study dissected the plots of the curve causality.Practical implicationsIn view of the results, some crucial policy implications could be suggested, such as, under certain circumstances and as an exceptional case, the use of policy instruments such as targeted investment, marketing and the support of tourism organizations focused on driving a tourism-led-based productivity and/or tourism programs and projects.Originality/valueThe current work is distinguished from the existing body of understanding in several substantial directions. This work explores, for the first time, the linkages between the total factor productivity index and tourism growth for Latin American countries. No single attempt has been known to investigate this interaction by using nonlinear causality, and this study determines the shape of the curve between the total factor productivity index and tourism growth for each country.

Time Cost of Provider Skill: A Pilot Study of Medical Officer Occupied Time By Knowledge, Skill, and Ability Level.

INTRODUCTION: On space missions one must consider the operating cost of the medical system on crew time. Medical Officer Occupied Time (MOOT) may vary significantly depending on provider skill. This pilot study assessed the MOOT Skill Effect (MOOTSkE).METHODS: An expert surgeon (ES), fifth year surgical resident (PGY5), second year surgical resident (PGY2), and an expert Emergency Physician (EP) with only 4 mo direct surgical training each performed two simulated appendectomies. The completion times for endotracheal intubation, appendectomy, and two subprocedures (multilayer tissue repair and single layer tissue repair) were recorded.RESULTS: The ES performed the appendectomy in 410 s, the PGY-5 in 498 s, the PGY-2 in 645 s, and the EP in 973 s on average. The PGY-2 and EP time difference was significant compared to the expert. The PGY-5 was not. The EP's time was significantly longer for the appendectomy and the multilayer repair than either surgical resident. For the single layer repair, only the EP-ES difference was significant. A single intubation attempt by the PGY-2 took 73 s while the EP averaged 27 s. The average recorded MOOTSkE between novice and expert was 2.5 (SD 0.34).DISCUSSION: This pilot study demonstrates MOOTSkE can be captured using simulated procedures. It showed the magnitude of the MOOTSkE is likely substantial, suggesting that a more highly trained provider may save substantial crew time. Limitations included small sample size, limited number of procedures, a simulation that may not reflect real world conditions, and suboptimal camera angles.Levin DR, Siu M, Kramer K, Kelly E, Alouidor R, Fernandez G, Kamine T. Time cost of provider skill: a pilot study of medical officer occupied time by knowledge, skill, and ability level. Aerosp Med Hum Perform. 2022; 93(11):816-821.

Nasal high-flow therapy to Optimise Stability during Intubation: the NOSI pilot trial

ObjectiveIn adult patients with acute respiratory failure, nasal high-flow (NHF) therapy at the time of intubation can decrease the duration of hypoxia. The objective of this pilot study was to...

Smartphone as an electronic stethoscope: factors influencing heart sound quality.

Smartphones are equipped with a high-quality microphone which may be used as an electronic stethoscope. We aim to investigate the factors influencing quality of heart sound recorded using a smartphone by non-medical users. An app named Echoes was developed for recording heart sounds using iPhone. Information on phone version and users' characteristics including sex, age, and body mass index (BMI) was collected. Heart sound quality was visually assessed and its relation to phone version and users' characteristics was analysed. A total of 1148 users contributed to 7597 heart sound recordings. Over 80% of users were able to make at least one good-quality recording. Good-, unsure- and bad-quality recordings amounted to 5647 (74.6%), 466 (6.2%) and 1457 (19.2%), respectively. Most good recordings were collected in the first three attempts of the users. Phone version did not significantly change the users' success rate of making a good recording, neither was sex in the first attempt (P = 0.41) or the first three attempts (P = 0.21). Success rate tended to decrease with age in the first attempt (P = 0.06) but not the first three attempts (P = 0.70). BMI did not significantly affect the heart sound quality in a single attempt (P = 0.73) or in three attempts (P = 0.14). Smartphone can be used by non-medical users to record heart sounds in good quality. Age may affect heart sound recording, but hardware, sex, and BMI do not alter the recording.

Phantom and Animal Study of a Robot-Assisted, CT-Guided Targeting System using Image-Only Navigation for Stereotactic Needle Insertion without Positional Sensors

PurposeTo evaluate the feasibility and accuracy of a robotic system to integrate and map computed tomography (CT) and robotic coordinates, followed by automatic trajectory execution by a robotic arm. The system was hypothesized to achieve a targeting error of <5 mm without significant influence from variations in angulation or depth. Materials and MethodsAn experimental study was conducted using a robotic system (Automated Needle Targeting device for CT [ANT-C]) for needle insertions into a phantom model on both moving patient table and moving gantry CT scanners. Eight spherical markers were registered as targets for 90 insertions at different trajectories. After a single ANT-C registration, the closed-loop software targeted multiple markers via the insertion of robotically aligned 18-gauge needles. Accuracy (distance from the needle tip to the target) was assessed by postinsertion CT scans. Similar procedures were repeated to guide 10 needle insertions into a porcine lung. A regression analysis was performed to test the effect of needle angulation and insertion depth on the accuracy of insertion. ResultsIn the phantom model, all needle insertions (median trajectory depth, 64.8 mm; range, 46.1–153 mm) were successfully performed in single attempts. The overall accuracy was 1.36 mm ± 0.53, which did not differ between the 2 types of CT scanners (1.39 mm ± 0.54 [moving patient table CT] vs 1.33 mm ± 0.52 [moving gantry CT]; P = .54) and was not significantly affected by the needle angulation and insertion depth. The accuracy for the porcine model was 9.09 mm ± 4.21. ConclusionsRobot-assisted needle insertion using the ANT-C robotic device was feasible and accurate for targeting multiple markers in a phantom model.

Factors associated with single and multiple suicide attempts in adolescents attending school in Argentina: national cross-sectional survey in 2018.

Factors associated with single suicide attempts (SSA) and multiple suicide attempts (MSA) may differ. The study aimed to assess the factors associated with MSA in adolescents with a history of suicide attempts during the past 12 months in Argentina. National cross-sectional data from the Global School-based Student Health Survey in Argentina in 2018 were analysed. Students who reported having a history of suicide attempts in the past 12 months were included in the final sample (n = 8507). Students with MSA were compared with students with an SSA through multiple logistic regression. In a subsample of adolescents attending school (mean age 14.8 years, s.d. = 1.3), 59.4% had an SSA and 40.6% had MSA in the past 12 months. In the final adjusted logistic regression model, compared with participants with SSA, both male and female students with MSA more frequently had no close friends, reported feeling more lonely and had more anxiety-induced sleep disturbances. Furthermore, among female participants, having been physically attacked, having participated in physical fights, low parental support, current tobacco use and lifetime amphetamine use were associated with MSA. Among male students, multiple sexual partners were associated with MSA. Furthermore, among both boys and girls, compared with participants without psychosocial distress, participants with one, two, three or more psychosocial distress factors had higher odds of MSA. Compared with students with one or two social or environmental risk factors, students with seven or eight social or environmental risk factors had higher odds of MSA; compared with students who had zero or one health risk behaviours, students with six or more health risk behaviours had higher odds of MSA. Psychosocial distress (anxiety-induced sleep disturbance, having no close friends and loneliness) increased the odds of MSA among both sexes. The odds of MSA were increased by interpersonal violence, low parental support and substance use among girls, and by having multiple sexual partners among boys. This suggests the potential relevance of these variables in identifying multiple suicide attempters among adolescents attending school in Argentina.

Introduction

Introduction

Feasibility Study on using MCDM for E-Voting

An online voting system is an election system that manages the election process. This is a medium for the voters to cast their votes. It is also being used to calculate the votes collected from the voters to choose the representative for their own faculty. A typical voting system is based on a single attempt for each candidate being voted. The voting does not reflect the criteria implies to the characteristic of the candidate that going to be the student leader. To be a student leader, the student should fulfil the requirement such as good academic results, interpersonal skills with society, involving in activities of university and etc. Although the current voting system is able to maximize the participation of the voters, the voters may blindly vote the ballots casually due to they do not know the details of the candidates and the result is low quality and low public’s trust in the selected candidate. In this study, the aim is to develop an interactive online voting system that have ranking feature with MCDM method which allow online voting system to collect high-quality results from the voters. The Multiple Criteria Decision Making (MCDM) method is used in the voting system while choosing the candidate. MCDM can let the voters make decision making or selecting the candidate based on the criteria that suit the position. The study starts with the literature study on implementing MCDM for a voting system. Then, a survey will be made to get the users’ views on the with and without implementation of the MCDM method in an online voting system. The expected result of the study is to investigate the current implementation of MCDM as a tool for decision making, then identify the possibility of adopting MCDM for the online voting system while choosing the representative for faculty students’ society. As a conclusion from the survey from the users’ views, it shown that most of the users thinks that the system with the implementation with MCDM method is less time consuming and able to produce high quality result compare to the current online voting system. Most of the respondents also stated that they are more preferring to use the online voting system with MCDM method in the future.

Laparoscopic Common Bile Duct Clearance, is It Feasible and Safe After Failed Endoscopic Retrograde Cholangiopancreatography?

Introduction: Concomitant gallstones and common bile duct (CBD) stones is a common problem, and there is still no consensus on the best approach in the management. Options include preoperative endoscopic retrograde cholangiopancreatography (ERCP), Laparoscopic cholecystectomy (LC) with CBD exploration, and LC with postoperative ERCP. Each option has its own limitations and complications. In this article, we assessed the feasibility of laparoscopic surgical clearance of the CBD after a failed ERCP, reasons for failure of endoscopic clearance in our cohort. We will discuss the management options after ERCP failure, the challenges, and the outcomes. Materials and Methods: We retrospectively reviewed all the cases of laparoscopic common bile duct exploration (LCBDE) performed in our hospital between April 2006 and January 2019. Two hundred cases were performed, 178 cases as a primary procedure while 22 were performed as a secondary procedure after failed ERCP. We have previously published data on the case series (PMID 33140155) and here explored the cases performed after failed ERCP as a secondary procedure. We analyzed demographics of patients, preoperative investigations, ERCP trials, and reasons for ERCP failure, operative approach, duration of operation, conversion rate, complications, and outcomes. Results: Twenty-two patients underwent a laparoscopic CBD clearance after failed ERCP. Sixteen of these were in the first 5 years of the study. Multiple attempts of ERCP were made in 7 patients (31.8%) and a single attempt in 15 patients. In 8 patients (32%), the duct was not accessible (failed cannulation) due to a variety of reasons. Nine patients had impacted stones larger than 1 cm, 4 patients had Mirrizi syndrome with concomitant large CBD stones, and 1 patient failed endoscopic clearance because of the large number of stones in the CBD. CBD clearance was successful in 19 patients (88%), 8 were completed by a transcystic approach and 14 by a transcholedochal approach. Postoperative length of stay was 12 (+10) days. One patient had an unplanned readmission within 30 days. One patient required reoperation for bleeding. Three patients developed recurrent stones and 1 developed a subsequent stricture. No mortalities were recorded. Conclusion: LCBDE is feasible and appears safe as a secondary procedure after failed ERCP. The new technologies and the advancement of surgical techniques will continue to improve success and reduce morbidity.

Youth suicide and hospital-presenting suicide attempts: Examination of risk factors for multiple suicide attempts in adolescence.

The suicide rate among adolescents around the world has increased rapidly. There are many risk factors for attempting suicide, but not all have been clarified yet. Therefore, it is very important to identify risk factors. This study evaluated adolescents with a history of suicide attempts and their association with chronic diseases. Besides, to check whether they attempted suicide multiple times. Other clinical features related to multiple suicide attempts were investigated. This study used a multicentre, retrospective cross-sectional design; 253 adolescents admitted to emergency departments in 2019 for suicide attempts were evaluated. Adolescents with chronic disease were at greater risk for both single and multiple suicide attempts and patients had a 6.14 times higher risk of multiple attempts (p = .013). The likelihood of multiple attempts did not differ according to the presence of somatic or psychiatric disease. Multiple attempters were more likely to poison themselves with their therapeutic drugs (p = .002). When adolescents with a chronic disease present to the emergency services after a single suicide attempt using their therapeutic drugs, families should be informed regarding the potential for further attempts.

Characterization of the Difficult Peripheral IV in the Perioperative Setting: A Prospective, Observational Study of Intravenous Access for Pediatric Patients Undergoing Anesthesia.

BackgroundVarious criteria exist for defining difficult intravenous access (DIVA) in infants and children. The current study evaluated the factors associated with DIVA in a prospective cohort of over 1000 infants and children presenting for anesthetic care.MethodsThis was a prospective, observational study of patients aged 0 to 18 years undergoing elective surgical or radiologic procedures under general anesthesia. Prior to the initial attempt at peripheral intravenous (PIV) cannulation, the anticipated difficulty of PIV catheter placement was determined by the provider using a visual analogue scale (VAS) from 1 to 10. The number of attempts was recorded as well as the time required to achieve PIV access. DIVA was defined as requiring three or more attempts. After successful cannulation, the actual difficulty of the PIV placement was assessed by the provider and recorded using the same VAS. Patient characteristics, including age, race, body mass index (BMI), American Society of Anesthesiologists (ASA) physical classification, and history of difficult PIV placement, were evaluated as covariates.ResultsIn our cohort of 1002 pediatric patients, 78% of patients were successfully cannulated in a single attempt and 91% of patients were successfully cannulated in two or fewer attempts. Factors associated with requiring three or more PIV attempts included younger age (OR 8.73; 95% CI: 3.38, 22.6 for age <1 year and OR 4.93; 95% CI: 2.05, 11.8 for age 1–3 years), higher ASA physical classification (OR 1.95; 95% CI: 1.10, 3.46 for ASA II), and prior history of difficult PIV placement (OR 3.46; 95% CI: 1.70, 7.08). BMI, racial category or gender were not independent predictors of DIVA.ConclusionWe found that approximately 9% of patients required three or more attempts at IV placement in the operating room. Patients that required multiple PIV attempts were more likely to be younger, have a higher ASA classification or a history of difficult PIV placement.