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

Abstract

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.

Precordial Doppler to assess vascular access in children: A preliminary report

“…Our former study showed that precordial Doppler was feasible, safe, and easy to use for accurate confirmation of PIV access placement in children who have undergone elective surgery in an operating suite. 8 In the current pilot study in a PICU setting, several patients had been extubated and were off deep sedation, therefore, physical movement and the sound of crying during precordial Doppler measurements could affect the outcomes of the S and V tests. Nevertheless, noise from physical movement and crying could be easily differentiated from the precordial Doppler sound and its changes in quality and pitch by injecting an NS bolus.…”

Optimal dose of normal saline for confirming correct peripheral venous access with precordial Doppler ultrasonography: a triple-blinded, randomized controlled study

“…The cut-off value of 1 cm/s was based on the validation results of a previous study. [5] Outcomes The primary outcomes were 1) the proportion of cases with a detected change in precordial Doppler sounds (S-test) and 2) the proportion of cases with a change in mean blood ow velocity of ≥ 1 cm/s in the 5-second period before and after NS injection via PIV access.…”

“…The proportion of positive S-tests was set at 50% for the 0.1 mL/kg dose, 70% for the 0.3 mL/kg dose, and 90% for the 0.5 mL/kg dose, based on our previous investigation. [5] The total estimated sample size was determined to be 375 (125 per group), based on the results of a chi-square test that assumed a Type error of 0.016 and Type error of 0.2. After allowing for a 5% data loss due to unusable or missing data, we aimed to recruit a total of 394 participants.…”

“…A small amount of normal saline (NS) is then administered via a PIV line to induce changes in the Doppler signals. [5,6] We previously used an NS injection dose of 0.5 mL/kg, based on ndings obtained from a small, exploratory data set. [5,6] Therefore, the minimally required dose of NS for con rming correct PIV placement remains unknown.…”

“…[5,6] We previously used an NS injection dose of 0.5 mL/kg, based on ndings obtained from a small, exploratory data set. [5,6] Therefore, the minimally required dose of NS for con rming correct PIV placement remains unknown. In small children, the repetitive intraoperative administration of NS in this precordial ultrasound technique can lead to unnecessary volume load.…”