Introduction of color‐flow injection test to confirm intravascular location of peripherally placed intravenous catheters

Gautam, Nischal K.; Bober, Kayla R.; Cai, Chunyan

doi:10.1111/pan.13188

Cited by 11 publications

(19 citation statements)

References 19 publications

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“…11 Our study shows that clinical evaluations including free flow from a hanging bag, free saline flush and blood aspiration, are poor indicators of vein infiltration. A similar finding was documented by Gautam et al 8 in pediatric patients, with detection of 100% of 27 venous catheters by color flow Doppler. Inadvertent extravascular position of a venous catheter is associated with deleterious outcomes.…”

Section: Discussionsupporting

confidence: 87%

“…Sample size was based on convenience and feasibility, and on a prior experience with the color flow Doppler evaluation of peripheral intravenous catheters in a pediatric population. 8 We calculated a sample size of 150 patients that was increased to 174 to account for possible cases with incomplete information. All statistical analyses were performed using SAS 9.4 and statistical significance was assessed using an alpha level of 0.05.…”

Section: Discussionmentioning

confidence: 99%

“…On the contrary, utilization of color flow Doppler technology with flow injection test has been shown to be a valuable tool for early recognition of malfunctioning intravenous catheters. 8 The color flow Doppler flow technique is both safe and reliable, and aids in identification of correct intravascular position of venous catheters in children.…”

Section: Introductionmentioning

confidence: 99%

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Utility of color flow Doppler ultrasound to identify peripheral intravenous catheter position in adult surgical patients

et al. 2020

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Objective: To evaluate color flow Doppler flow ultrasound compared to standard clinical techniques, to detect the intravascular position of peripheral intravenous catheters in adult surgical patients. Methods: A prospective study was conducted in adult (>18 years old) patients scheduled to undergo elective surgery. Peripheral intravenous catheter position was evaluated with standard clinical techniques (free flow of fluid from a hanging bag, easy saline injection, and aspiration of blood), and with color flow Doppler ultrasound proximal to the insertion site to identify intravascular catheter position. Comparative test performance was carried out. Results: In total, 174 patients were enrolled. The venous catheter was deemed to be intravascular in 92.53% ( n = 161) and 90.23% ( n = 157) based on clinical evaluation and color flow Doppler, respectively ( p = 0.206). Moderate to substantial agreement between the two approaches was found. Cohen’s kappa was 0.64 (95% CI 0.43–0.83). Specificity of clinical judgment to detect catheter extravascular position was only 58.82%, when the color flow Doppler technique was set as the gold standard. Free flow from a hanging bag method showed the best agreement with color flow Doppler to determine intravascular position of a catheter ( p = 0.3173, kappa = 0.68), with sensitivity of 98.09% and specificity of 64.71%. Conclusion: Color flow Doppler is a specific tool complementary to sensitive clinical indicators to detect peripheral venous catheter infiltration. The ability of color flow Doppler to accurately determine the position of a peripheral venous catheter depends on experience and familiarity with the tool by providers, who can master the technique with education and training.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Utility of color flow Doppler ultrasound to identify peripheral intravenous catheter position in adult surgical patients

et al. 2020

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“…Concerns regarding intravenous catheter migration or malfunction are high priorities in pediatric anesthesia because of the lack of consistently accurate diagnostic measures. Several verification methods have been reported previously [1,5,6]. However, these diagnostic methods are not widely accepted because of the potential adverse effects of medications and the complexity of the procedures.…”

Section: Introductionmentioning

confidence: 99%

Introduction of precordial Doppler ultrasound to confirm correct peripheral venous access during general anesthesia in children: A preliminary study

Kojima¹,

Kitamura²,

Ichiyanagi³

et al. 2021

PLoS ONE

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Background Delayed identification of infiltration and dysfunction of peripheral intravenous (PIV) access can lead to serious consequences during general anesthesia in children. This preliminary study aimed to describe the application of precordial Doppler ultrasound during general anesthesia in children to detect and confirm the correct PIV access and to evaluate the accuracy of this method. Methods This was a single-center, preliminary study that was conducted in children (<18 years) who were scheduled for elective surgeries between October 2019 and March 2020. Rater anesthesiologists judged the change in precordial Doppler sound (S test) before and after injection of 0.5 mL/kg of normal saline (NS) via PIV. Blood flow velocity before and after NS injection was recorded, and multiple cutoff points were set to analyze the accuracy of detecting the infiltration and dysfunction of PIV catheter (V test). Results The total incidence of peripheral infiltration and dysfunction of PIV catheter was 7/512 (1.4%). In the S test, the sensitivity, specificity, positive and negative likelihood ratios, and area under the receiver-operating characteristic curves (AUCs) were 5/7 (71.4%; 95% confidence interval [CI], 29.0%–96.3%), 490/505 (97.0%; 95% CI, 95.1%–98.3%), 24.0, 0.29, and 0.84, respectively. The V test showed that the reasonable threshold of blood flow velocity change was 1.0 m/s, with sensitivity, specificity, positive and negative likelihood ratios, and AUC of 4/7 (57.1%; 95% CI, 18.4%–90.1%), 489/505 (96.8%; 95% CI, 94.9%–98.2%), 18.0 and 0.44, and 0.84, respectively. Conclusions This preliminary study demonstrated that precordial Doppler ultrasound is a feasible, easy-to-use, and noninvasive technique with good accuracy to confirm the correct PIV access during general anesthesia in children. However, its accuracy requires further evaluation.

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“…Colourflow Doppler has also been described as a means of confirming intravenous placement in children and is readily implemented. 19 Airway and pulmonary…”

Section: Peripheral Venous Accessmentioning

confidence: 99%

Point-of-care ultrasound in pediatric anesthesiology and critical care medicine

Dalesio

Pustavoitau

2018

Can J Anesth/J Can Anesth

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Ultrasound has increasingly become a clinical asset in the hands of the anesthesiologist and intensivist who cares for children. Though many applications for ultrasound parallel adult modalities, children as always are not simply small adults and benefit from the application of ultrasound to their management in various ways. Body composition and size are important factors that affect ultrasound performance in the child, as are the pathologies that may uniquely afflict children and aspects of procedures unique to this patient population. Ultrasound simplifies vascular access and other procedures by visualizing structures smaller than those in adults. Maturation of the thoracic cage presents challenges for the clinician performing pulmonary ultrasound though a greater proportion of the thorax can be seen. Moreover, ultrasound may provide unique solutions to sizing the airway and assessing it for cricothyroidotomy. Though cardiac ultrasound and neurosonology have historically been performed by well-developed diagnostic imaging services, emerging literature stresses the utility of clinician ultrasound in screening for pathology and providing serial observations for monitoring clinical status. Use of ultrasound is growing in clinical areas where time and diagnostic accuracy are crucial. Implementation of ultrasound at the bedside will require institutional support of education and credentialing. It is only natural that the pediatric anesthesiologist and intensivist will lead the incorporation of ultrasound in the future practice of these specialties.

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Introduction of color‐flow injection test to confirm intravascular location of peripherally placed intravenous catheters

Cited by 11 publications

References 19 publications

Utility of color flow Doppler ultrasound to identify peripheral intravenous catheter position in adult surgical patients

Utility of color flow Doppler ultrasound to identify peripheral intravenous catheter position in adult surgical patients

Introduction of precordial Doppler ultrasound to confirm correct peripheral venous access during general anesthesia in children: A preliminary study

Point-of-care ultrasound in pediatric anesthesiology and critical care medicine

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