Peripheral Difficult Venous Access in Children

Abstract

discuss management strategies. This article summarizes the recommendations of the consensus panel for physicians. The recommendations for nurses will be published separately. Definition and Scope of the ProblemEarly identification of DVA is the first step in optimizing patient care. The consensus panel described DVA as a clinical condition in which multiple attempts and/or special interventions are anticipated or required to achieve and maintain peripheral venous access. Special interventions are defined as the use of any technique or hospital resource with the potential to improve peripheral IV insertion success rates. These include traditional methods of enhancing the visibility and palpability of peripheral veins (eg, warming the catheter site to induce vasodilation) [10][11][12] ; advanced visualization technologies such as ultrasound, transillumination, and nearinfrared lighting 2,[13][14][15] ; and enlisting designated IV specialists and/or hospital staff with extensive experience in starting pediatric IVs.16 Some children may need more invasive interventions such as intraosseous (IO) infusion, a peripherally inserted central catheter, or a central venous catheter (CVC) to achieve parenteral access.There is a dearth of clinical evidence on the incidence of DVA in pediatric patients. Studies of IV insertion success rates indicate that 5% to 33% of children require more than 2 needle sticks to achieve IV access. [1][2][3][4] Even when interventions such as transillumination and ultrasound are used, up to 15% of children still require more than 2 attempts to establish venous access.2 A recent prospective analysis of 593 insertion attempts in centers with pediatric hospitalist services showed that successful placement E stablishing peripheral intravenous (IV) access in pediatric patients can be challenging. Clinical studies show that only 53% to 76% of children are successfully cannulated on the first attempt.1-4 Multiple failed attempts are painful and upsetting for the child and distressing for family members and caregivers, 5-9 yet there are no guidelines or consensus statements on the recognition and management of this problem.In January 2008, a panel of physicians and nurses specializing in emergency medicine, anesthesia, critical care, and hospital medicine convened to discuss peripheral difficult venous access (DVA) in children. Daniel Rauch, MD, FAAP, and Laura L. Kuensting, MSN(R), RN, CPNP, cochaired the roundtable discussion, which was made possible by a grant from Baxter Healthcare, Inc. The main objectives of the meeting were to estimate the frequency of DVA in pediatric patients; describe its clinical and emotional impact on the patient, the patient's family, and clinicians; develop terminology that accurately describes the condition; review the factors that help identify children with DVA; and

Predisposing factors for peripheral intravenous puncture failure in children

“…The researchers in the present study, however, did not observe this association, in view of the restricted number Authors cite that some of these conditions can impede success in the procedure (4)(5)7,14,(18)(19) . In the present study, however, the researchers did not identify which clinical condition was most significant, due to the high number of associations between the same for each child.…”

Influence of Therapeutic Play on the anxiety of hospitalized school-age children: Clinical trial

“…Patients who had undergone at least one peripheral intravenous puncture were selected because research shows an increased degree of anxiety and sensation of pain in children who underwent multiple punctures and because it is one of the most invasive procedures performed during hospitalization (14)(15)(16) . Convenience sampling was used and limited by the study duration.…”

Ultrasound-guided vascular cannulation. Experience in critically-ill pediatric patients

“…[1][2][3][4] In pediatric patients, the failure rate associated to the technique based on anatomical landmarks ranges from 20% to 55%, and the complications rate, from 10% to 25%. [4][5][6][7][8] These complications, as well as vessel cannulation failure, increase in shock, dehydration, swelling or coagulopathy situations, which are generally associated to the criticallyill patient.…”