801 - Success of Peripheral Intravenous Line Placement in Pediatric Patients Using Ultrasound-Guidance Technique
Friday, May 15, 2020
Location: Majestic Ballroom: Majestic
Objectives: Pediatric peripheral intravenous (PIV) access is a challenge, with some pediatric patients experiencing multiple PIV attempts prior to successful placement. Placement of a PIV under ultrasound guidance (USGPIV) is well studied in adult patients, but data are limited on the application of USGPIV in pediatric emergency department patients. The authors theorized that using USGPIV would assist in successful PIV placement in patients that had proven or anticipated difficult IV access.
Methods: This is a retrospective observational study at an urban pediatric emergency department. Seven emergency department nurses received hands-on training for USGPIV insertion and began performing USGPIV when traditional PIV had failed or patients were felt to be a difficult stick. As part of routine quality improvement, data for each USGPIV were collected at the time of placement including age, site, number of attempts, success rate, and dwell time. For analysis, records for eligible children were deidentified for the research team. Children who were 18 years and under and received a PIV using ultrasound guidance between June 2018 and July 2019 were included. The primary outcome was success rate of USGPIV placement. Secondary outcomes were median dwell time and complication rates.
Results: There were 94 eligible patients who had attempted USGPIV placement after a total of 185 PIV attempts by traditional methods. Patients’ ages ranged from 11 days to 18 years (mean 8.3 years). The most common USGPIV placement site was left antecubital fossa (27, 30%) and most common size was 22 gauge (49, 53.2%). Placement was successful in 84 (91.3%) of patients and only 15 (16.3%) of patients required more than one USGPIV stick. Nine patients were not able to have a PIV placed even with ultrasound-guidance. Of the ninety patients who were predicted by the nurse to be a “hard stick”, 81% achieved IV access on the first or second attempt with ultrasound-guidance. Dwell time was available on 36 patients, with 32 (89%) of these patients keeping their USGPIV until hospital discharge.
Conclusion: Using ultrasound-guidance for PIV placement in pediatric patients was successful, with most achieving IV access on the first USGPIV stick. This should be implemented as an option for IV access in pediatric patients in all emergency departments and training for this skill should be utilized by nurses, advanced practice providers, and physicians.