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

Heinrichs, Jeffrey; Fritze, Zachary; Klassen, Terry P.; Curtis, Sarah

doi:10.1097/pec.0b013e3182999bcd

Cited by 38 publications

(27 citation statements)

References 31 publications

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“…71 However, recommendations for other visualization techniques in pediatric populations, including NIR light (vessel visualization) and ECG (catheter-tip confirmation) device use, were scant. Use of NIR light devices may be efficacious in selected high-risk subpopulations 102 and may modestly improve first-attempt success rates 77,104,110 ; however, the current evidence does not support an overall benefit 74 or a benefit that is better than non-image-guided methods. 104 Similarly, low levels of evidence prevent the recommendation of ECG assistance for PICC placement 105 ; however, one study also found higher first-attempt success and correct tip position success by using intracavitary ECG PICC insertion compared to landmark techniques.…”

Section: Vessel Visualizationmentioning

confidence: 67%

Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review

et al. 2020

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OBJECTIVE: To critically review the evidence for the selection and insertion of pediatric vascular access devices (VADs). DATA SOURCES: Data were sourced from the US National Library of Medicine, Cumulative Index to Nursing and Allied Health, the Cochrane Library databases, Embase, and international clinical trial databases. STUDY SELECTION: Clinical practice guidelines, systematic reviews, cohort designs, randomized control trials (RCTs), quasi RCTs, before-after trials, or case-control studies that reported on complications and/or risk as well as reliability of VADs in patients aged 0 to 18 years were included. DATA EXTRACTION: Articles were independently reviewed to extract and summarize details on the number of patients and catheters, population, age of participants, VAD type, study method, indication, comparators, and the frequency of VAD failure or complications. RESULTS: VAD selection and insertion decision-making in general hospitalized and some specialized patient populations were well evidenced. The use of single-lumen devices and ultrasound-guided techniques was also broadly supported. There was a lack of RCTs, and for neonates, cardiac patients, patients with difficult venous access, midline catheters, catheter-tovein ratio, and near-infrared devices, the lack of evidence necessitated broadening the review scope. LIMITATIONS: Limitations include the lack of formal assessment of the quality of evidence and the lack of RCTs and systematic reviews. Consequently, clinical decision-making in certain pediatric populations is not guided by strong, evidence-based recommendations. CONCLUSIONS: This is the first synthesis of available evidence for the selection and insertion of VADs in pediatric patients and is important for determining the appropriateness of VADs in pediatric patients. WHAT'S KNOWN ON THIS SUBJECT: Individual studies, systematic reviews, and focused clinical practice guidelines that evaluate vascular access devices (VADs) in various pediatric populations are available. However, to date, no systematic review examining the appropriateness, and inappropriateness, of VADs across common pediatric clinical scenarios exists. WHAT THIS STUDY ADDS: There is strong evidence to support and facilitate appropriate clinical decision-making in some pediatric indications. However, certain populations, device types and characteristics, and insertion procedures are poorly evidenced, necessitating the application of clinical judgment for VAD decision-making.

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Section: Vessel Visualizationmentioning

confidence: 67%

Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review

et al. 2020

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“…Peripheral venous cannulation is the commonest, and probably the most important invasive procedure practised in hospitals. Principles are summarised in Table .…”

Section: Peripheral Venous Cannulationmentioning

confidence: 99%

Association of Anaesthetists of Great Britain and Ireland: Safe vascular access 2016

et al. 2016

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SummarySafe vascular access is integral to anaesthetic and critical care practice, but procedures are a frequent source of patient adverse events. Ensuring safe and effective approaches to vascular catheter insertion should be a priority for all practitioners. New technology such as ultrasound and other imaging has increased the number of tools available. This guidance was created using review of current practice and literature, as well as expert opinion. The result is a consensus document which provides practical advice on the safe insertion and removal of vascular access devices.

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“…In our study, nearly all patients with initial insertion failure experienced successful PIV insertion by the VAT, who used POCUS for 50% of patients to evaluate peripheral veins before attempts, and for 40% during active PIV insertion. POCUS‐enhanced PIV insertion has been supported in recent studies regarding DIVA in both adult and pediatric patients . We intend to use these results to inform an interventional study involving the use of POCUS by PED providers in patients at risk of prolonged PIV insertion or failure who require vascular access in the resuscitation area of our PED.…”

Section: Discussionmentioning

confidence: 76%

Video‐based Assessment of Peripheral Intravenous Catheter Insertion in the Resuscitation Area of a Pediatric Emergency Department

Vukovic

Frey

Byczkowski

et al. 2016

Academic Emergency Medicine

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Objective: The objective was to describe the frequency of and factors associated with prolonged peripheral intravenous catheter (PIV) insertion in the resuscitation area of a pediatric emergency department (PED).Methods: Video-based study of a consecutive sample of nontrauma patients undergoing PIV insertion in the resuscitation area of a PED. Preexisting videos were the main data source. The primary outcome was patients with prolonged duration of PIV insertion (>90 seconds from start of first attempt to successful flush/blood draw). Logistic regression identified variables independently associated with prolonged PIV insertion.Results: A total of 151 consecutive nontrauma patients underwent PIV insertion during a 2.5-month period. Sixty-nine patients (46%) had prolonged PIV insertion, including 14 for whom PED providers failed to insert PIVs. For patients with successful PIV insertion by PED providers, median duration was 48 seconds (interquartile range [IQR] = 23 to 295 seconds). Vascular access was ultimately achieved for 13 patients (93%) with initial insertion failure by the PED team (10 non-PED personnel, three intraosseous lines), with a median duration of 26.7 minutes (IQR = 19.9 to 34.2 minutes). Age ≤ 2 years (OR adj = 6.9; 95% confidence interval [CI] = 2.9 to 16.1) and musculoskeletal contractures (OR adj = 5.3; 95% CI = 1.6 to 17.2) were independently associated with prolonged PIV insertion.Conclusions: Prolonged PIV insertion is common in a PED resuscitation area. When PED providers could not insert a PIV, time to insertion was very long. Young patients and those with contractures were at particular risk for prolonged and failed PIV placement. When emergent vascular access is required, alternative approaches should be considered early for these patients.ACADEMIC EMERGENCY MEDICINE 2016;23:637-644 © 2016 by the Society for Academic Emergency Medicine P eripheral intravenous catheter (PIV) insertion is one of the most common and essential procedures in medicine. For patients in pediatric acute care settings, PIVs may be required for diagnostic and therapeutic interventions. Under nonemergent conditions in a pediatric emergency department (PED), PIV insertion is reportedly successful on approximately 75% of initial attempts; 1-7 PIV insertion ultimately fails for around 10% of patients with at least one attempt. 2,8Although first-attempt success is the commonly reported measure, our experience and the relevant literature suggest that timeliness may be a better quality measure for PIV insertion in a PED resuscitation area.9-12 The duration of PIV insertion, however, has only been measured in controlled settings where urgent or emer-

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

Cited by 38 publications

References 31 publications

Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review

Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review

Association of Anaesthetists of Great Britain and Ireland: Safe vascular access 2016

Video‐based Assessment of Peripheral Intravenous Catheter Insertion in the Resuscitation Area of a Pediatric Emergency Department

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