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Zaki HA, Elmelliti H, Ponappan B, Shaban A, Shaban A, Abosamak MF, Shaban EE. Outcomes of POCUS-Guided Peripheral Intravenous Access in Difficult Venous Access Patients: A Systematic Review and Meta-Analysis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2025. [PMID: 40329885 DOI: 10.1002/jcu.24059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Revised: 01/02/2025] [Accepted: 03/31/2025] [Indexed: 05/08/2025]
Abstract
Point Of Care Ultrasound (POCUS) guided peripheral intravenous (PIV) access offers a safer and more efficient alternative for patients with difficult venous access. A systematic review of 15 studies with 1485 patients, sourced from five databases, including PubMed, Cochrane Library, MEDLINE, Web of Science, and Google Scholar, showed POCUS significantly improved success rates (OR: 4.25), first-attempt success (OR: 5.31), reduced attempts (MD: -0.83), and decreased procedure time (MD: -9.75 min). Fewer complications (OR: 0.49) observed with POCUS compared to standard techniques. Statistical analyses were conducted using Review Manager, and quality was assessed with Cochrane Risk of Bias and Newcastle Ottawa tools. Findings support POCUS as a safe, time-saving procedure for improving patient outcomes.
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Affiliation(s)
- Hany A Zaki
- Emergency Medicine Department, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
| | - Hussam Elmelliti
- Emergency Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Benny Ponappan
- Emergency Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Shaban
- Internal Medicine Department, Mansoura University Hospital, Mansoura, Egypt
| | - Amira Shaban
- Internal Medicine Department, Mansoura University Hospital, Mansoura, Egypt
| | - Mohammed F Abosamak
- Department of Anesthesia and Intensive Care Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Eman E Shaban
- Cardiology Department, Al Jufairi Diagnosis and Treatment, MOH, Qatar
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Zilberfarb AL, Odunayo A, Garudadri P, Allen-Durrance A, Okafor C. The cephalic vein is readily accessible for vascular access in pediatric patients less than 12 weeks presenting to an emergency room. Front Vet Sci 2025; 12:1495039. [PMID: 40182642 PMCID: PMC11965629 DOI: 10.3389/fvets.2025.1495039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2024] [Accepted: 02/27/2025] [Indexed: 04/05/2025] Open
Abstract
Pediatric veterinary patients often require prompt medical intervention in emergency hospitals, commonly involving intravenous medications or fluids. This study aimed to characterize the most utilized venous access sites in pediatric puppies and kittens under 12 weeks of age in an emergency room setting. Ninety-four canine and 33 feline patients under 12 weeks old, with an intravenous catheter placed in the emergency room at the University of Florida, between January 1, 2021, and November 30, 2023 were included in this study. A retrospective evaluation of medical records was conducted to determine the most common vein utilized for venous access in pediatric patients. The median body weight was 4.19 kg (Q1, Q3: 2.50, 7.20) for puppies and 0.92 kgs (Q1, Q3: 0.43, 1.14) for kittens. The cephalic vein was the most common site in both species, utilized in 90.4% of puppies (85/94) and 78.8% of kittens (26/33). Puppies with lower body weights were more likely to have a catheter placed in the jugular vein; however, no significant correlation was found between the kittens' body weights and catheter site. The most used catheter size was 22G in both species. Ultimately, the cephalic vein appears to be consistently accessible for venous access in puppies and kittens under 12 weeks old, across a wide range of body weights. Catheters in the jugular vein may be preferred for puppies and kittens under 1.2 kg and 0.3 kg, respectively. Utilizing the cephalic vein for venous access may facilitate rapid and less technically challenging intravenous catheter placement in patients under 12 weeks old.
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Affiliation(s)
- Alexandra L. Zilberfarb
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, United States
| | - Adesola Odunayo
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, United States
| | - Prathima Garudadri
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, United States
| | - Ashley Allen-Durrance
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, United States
| | - Chika Okafor
- Department of Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville, Knoxville, TN, United States
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Kleidon TM, Schults JA, Royle RH, Gibson V, Ware RS, Andresen E, Cattanach P, Dean A, Pitt C, Ramstedt M, Byrnes J, Nelmes P, Rickard CM, Ullman AJ. First-Attempt Success in Ultrasound-Guided vs Standard Peripheral Intravenous Catheter Insertion: The EPIC Superiority Randomized Clinical Trial. JAMA Pediatr 2025; 179:255-263. [PMID: 39869351 PMCID: PMC11773401 DOI: 10.1001/jamapediatrics.2024.5581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 10/02/2024] [Indexed: 01/28/2025]
Abstract
Importance Pediatric peripheral intravenous catheter (PIVC) insertion can be difficult and time-consuming, frequently requiring multiple insertion attempts and often resulting in increased anxiety, distress, and treatment avoidance among children and their families. Ultrasound-guided PIVC insertion is a superior alternative to standard technique (palpation and visualization) in high-risk patients. Objective To compare first-time insertion success of PIVCs inserted with ultrasound guidance compared with standard technique (palpation and visualization) across all risk categories in the general pediatric hospital population. Design, Setting, and Participants An open-label, pragmatic, superiority, randomized clinical trial was conducted in an Australian quaternary pediatric hospital. Children (ages 0-18 years) requiring PIVC insertion were included between July 2021 and December 2022. One catheter was studied per patient, and analysis was by intention to treat. Data analysis was performed from April to October 2023. Intervention Eligible children were randomly assigned (1:1 using computer-generated randomization and concealed allocation) to receive ultrasound-guided or standard PIVC insertion. Randomization was stratified by insertion difficulty (low, medium, or high risk) defined using a standardized tool. Main Outcomes and Measures The primary outcome was first-time insertion success. Secondary outcomes included number of insertion attempts, insertion failure, postinsertion complications, dwell time, patient and parent satisfaction, and health care costs. Results A total of 164 children were randomly assigned to ultrasound-guided insertion (n = 84) or standard care (n = 80), with 81 (96.4%) and 78 (97.5%) receiving their allocated intervention, respectively. The median (IQR) age was 24 (10-120) months, and 93 children (56.7%) were male. First-time insertion success was higher with ultrasound-guided PIVC insertion (72 children [85.7%]) compared with standard technique (26 children [32.5%]) (risk difference [RD], 53.6%; 95% CI, 41.7%-65.4%; P < .001). Ultrasound-guided insertion led to significantly greater first-time insertion success across all risk categories, with the following RDs: low risk, 30.8% (95% CI, 8.1%-53.5%); medium risk, 56.2% (95% CI, 37.1%-75.3%); and high risk, 69.6% (95% CI, 52.3%-87.0%). Ultrasound-guided PIVC insertion had higher immediate health care costs (between group difference in total mean cost per person, A$9.33; 95% credible interval, A$8.83-A$10.86 [US $5.83; 95% credible interval, $5.52-$6.78]). Conclusion and Relevance These findings suggest that ultrasound-guided PIVC insertion improves first-time insertion success across all risk categories in pediatrics, supporting the widespread adoption of ultrasound-guided PIVC insertion in children. Trial Registration anzctr.org.au Identifier: ACTRN12621000206820.
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Affiliation(s)
- Tricia M. Kleidon
- Vascular Assessment and Management Service, Department of Anaesthesia and Pain, Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Schools of Nursing and Midwifery, and Pharmacy and Medical Sciences, Griffith University, Queensland, Australia
- School of Nursing, Midwifery, and Social Work, University of Queensland, Brisbane, Australia
| | - Jessica A. Schults
- Alliance for Vascular Access Teaching and Research, Schools of Nursing and Midwifery, and Pharmacy and Medical Sciences, Griffith University, Queensland, Australia
- School of Nursing, Midwifery, and Social Work, University of Queensland, Brisbane, Australia
- Herston Infectious Diseases Institute, Metro North Health, Queensland Health, Brisbane, Australia
| | - Ruth H. Royle
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Queensland, Australia
| | - Victoria Gibson
- Vascular Assessment and Management Service, Department of Anaesthesia and Pain, Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, Queensland, Australia
- School of Nursing, Midwifery, and Social Work, University of Queensland, Brisbane, Australia
- Children’s Health Research Centre, University of Queensland, Brisbane, Australia
| | - Robert S. Ware
- Alliance for Vascular Access Teaching and Research, Schools of Nursing and Midwifery, and Pharmacy and Medical Sciences, Griffith University, Queensland, Australia
- Griffith Biostatistics Unit, Griffith Health, Griffith University, Queensland, Australia
| | - Elizabeth Andresen
- Vascular Assessment and Management Service, Department of Anaesthesia and Pain, Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, Queensland, Australia
| | - Paula Cattanach
- Vascular Assessment and Management Service, Department of Anaesthesia and Pain, Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, Queensland, Australia
| | - Anna Dean
- Vascular Assessment and Management Service, Department of Anaesthesia and Pain, Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, Queensland, Australia
- School of Nursing, Midwifery, and Social Work, University of Queensland, Brisbane, Australia
| | - Colleen Pitt
- Vascular Assessment and Management Service, Department of Anaesthesia and Pain, Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, Queensland, Australia
- School of Nursing, Midwifery, and Social Work, University of Queensland, Brisbane, Australia
| | - Malanda Ramstedt
- Vascular Assessment and Management Service, Department of Anaesthesia and Pain, Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, Queensland, Australia
| | - Joshua Byrnes
- Alliance for Vascular Access Teaching and Research, Schools of Nursing and Midwifery, and Pharmacy and Medical Sciences, Griffith University, Queensland, Australia
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Queensland, Australia
| | - Patrick Nelmes
- Vascular Assessment and Management Service, Department of Anaesthesia and Pain, Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, Queensland, Australia
| | - Claire M. Rickard
- Alliance for Vascular Access Teaching and Research, Schools of Nursing and Midwifery, and Pharmacy and Medical Sciences, Griffith University, Queensland, Australia
- School of Nursing, Midwifery, and Social Work, University of Queensland, Brisbane, Australia
- Herston Infectious Diseases Institute, Metro North Health, Queensland Health, Brisbane, Australia
| | - Amanda J. Ullman
- Vascular Assessment and Management Service, Department of Anaesthesia and Pain, Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Schools of Nursing and Midwifery, and Pharmacy and Medical Sciences, Griffith University, Queensland, Australia
- School of Nursing, Midwifery, and Social Work, University of Queensland, Brisbane, Australia
- Children’s Health Research Centre, University of Queensland, Brisbane, Australia
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Putensen D, Ntakirutimana S, Lyon M, Audsley B, Newbound N. Implementation of Ultrasound-Guided Cannulation Training Across Eight NHSBT Therapeutic Apheresis Units in England. J Clin Apher 2024; 39:e22149. [PMID: 39420568 DOI: 10.1002/jca.22149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 08/27/2024] [Accepted: 09/28/2024] [Indexed: 10/19/2024]
Abstract
Ultrasound-guided cannulation (USGC) of a peripheral vein reduces the need for central vascular access device (CVAD) placement to perform a successful apheresis procedure. Effective training of healthcare professionals to acquire this skill is essential. Here, we report on the implementation of the USGC training across eight apheresis units in England. A 3-h introductory training program was devised with theoretical and practical elements. This was followed by supervised USGC practices on any patient ≥ 18 years old, regardless of venous status. Data on all supervised USGC attempts were recorded and analyzed. Over an 11-month period, 11 nurses were trained to USGC competency with another six nurses still in training, resulting in seven out of eight units having at least one USGC-competent nurse. In one unit, USGC training has not started yet. Three hundred sixty-one supervised USGC episodes on 168 patients and donors took place; of these, 178 were done for training purposes only on patients who had visible and palpable veins, 179 USGC were done on patients with difficult venous status and four were not recorded. The period from first supervised USGC to competency was a median of 45 days (Range: 17-166 days), with a median of 15 successful (Range: 10-30) and two unsuccessful (Range: 1-15) USGC being performed per trainee. The placement of 57 CVADs and 41 multiple cannulation attempts have been avoided. USGC is a useful tool to reduce the need for CVAD. Training across multiple apheresis units is a lengthy procedure, but it can be successfully implemented.
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Affiliation(s)
- Daniel Putensen
- National Health Service Blood and Transplant, Therapeutic Apheresis Services, Bristol, England
| | - Samuel Ntakirutimana
- National Health Service Blood and Transplant, Therapeutic Apheresis Services, Bristol, England
| | - Marc Lyon
- National Health Service Blood and Transplant, Therapeutic Apheresis Services, Bristol, England
| | - Bridget Audsley
- National Health Service Blood and Transplant, Therapeutic Apheresis Services, Bristol, England
| | - Nicola Newbound
- National Health Service Blood and Transplant, Therapeutic Apheresis Services, Bristol, England
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Schakett B, Huang G, Pranav H, Glover CD. Perioperative considerations in anesthesia for pediatric bariatric procedures. Semin Pediatr Surg 2024; 33:151460. [PMID: 39477767 DOI: 10.1016/j.sempedsurg.2024.151460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2024]
Abstract
Obesity is a global epidemic affecting a broad range of individuals, regardless of economic and social strata. In 2022, the World Health Organization (WHO) reported that 16 % of adults and 160 million children were living with this condition. The economic impact is significant, with a recent Milken report estimating the annual cost of obesity in the US at 1.4 trillion dollars, accounting for almost 7 % of the United States gross domestic product. It is widely recognized that the most severe forms of pediatric obesity (120 % of the 95th percentile for age and sex) represent an epidemic within an epidemic, given their potential for diminished long-term health and shortened lifespan. The treatment paradigm for obesity covers a range of approaches, with the American Academy of Pediatrics (AAP) recommending behavior and lifestyle modification as initial components of care. Since 2004, bariatric surgery has increasingly been utilized as an additional option for treating adolescent obesity, as long-term findings have shown sustained reductions in BMI and improvements in comorbid conditions. For anesthesiologists, these patients present specific challenges that require review.
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Affiliation(s)
- Brent Schakett
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Grace Huang
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Heena Pranav
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Chris D Glover
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
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Gürcan M, Karataş N, Kaya A, Turan SA, Güler E. The effect of a pushing technique with normal saline on peripheral intravenous catheter placement success in paediatric haematology and oncology: A randomized controlled trial. Eur J Oncol Nurs 2024; 71:102656. [PMID: 39002409 DOI: 10.1016/j.ejon.2024.102656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/28/2024] [Accepted: 06/29/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE The aim of the present study is to determine the effect of the pushing technique with saline on the success of peripheral IV catheter placement in a paediatric haematology and oncology sample. METHODS The randomized controlled trial was conducted among 60 paediatric haematology and oncology patients aged between 0 and 17. The participants were randomly assigned to two peripheral intravenous catheter placement groups (intervention group, n:30, control group, n:30). Each patient was evaluated with the Difficult Intravenous Access (DIVA) score before being included in the study. Each patient was assessed using the Personal Information Form for Children and Catheter Registration Form. RESULTS The average age of the children was 86.4 months (SD = 60.0); 36.7% were female. The pushing technique with saline significantly increased the success of placing a peripheral IV catheter on the first attempt in the intervention group compared to the control group (F = 42.391, p = 0.000). The number of attempts during peripheral IV catheter placement significantly decreased in the intervention group compared with the control group (t = -5.676, p = 0.000). Complications were less in the intervention group compared with the control group (χ2 = 24.438, p = 0.000). The procedure time was significantly shorter in the intervention group compared with the control group (t = -4.026, p = 0.000). CONCLUSION The pushing technique with saline is an effective method to increase the first attempt success rate, decrease the number of attempts, reduce the procedure time, and reduce the complications during peripheral intravenous catheter placement procedures in paediatric haematology and oncology patients with difficult intravenous access. TRIAL REGISTRATION This study was registered at ClinicalTrials.gov (NCT05685290 & date of first recruitment: January 3, 2023) https://clinicaltrials.gov/ct2/show/NCT05685290.
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Affiliation(s)
- Meltem Gürcan
- Paediatric Nursing Department, Faculty of Nursing, Akdeniz University, Antalya, Turkey.
| | - Nimet Karataş
- Paediatric Nursing Department, Faculty of Nursing, Akdeniz University, Antalya, Turkey.
| | - Ayla Kaya
- Paediatric Nursing Department, Faculty of Nursing, Akdeniz University, Antalya, Turkey.
| | - Sevcan Atay Turan
- Paediatric Nursing Department, Faculty of Nursing, Akdeniz University, Antalya, Turkey.
| | - Elif Güler
- Paediatric Hematology and Oncology Department, Akdeniz University Hospital, Akdeniz University, Antalya, Turkey.
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7
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Hinterstein S, Ehrhardt H, Zimmer KP, Windhorst AC, Kappesser J, Hermann C, Schuler R, Waitz M. Skin Transillumination Improves Peripheral Vein Cannulation by Residents in Neonates: A Randomized Controlled Trial. Neonatology 2024; 121:733-741. [PMID: 38754396 PMCID: PMC11633893 DOI: 10.1159/000538880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 04/10/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Establishing peripheral vein access is challenging for pediatric residents and a painful procedure for neonates. We assessed the efficacy of a red light-emitting diode transilluminator during peripheral vein catheter insertion performed by pediatric residents. METHODS Patients were stratified by current weight (≤1,500 g, >1,500 g) and randomized to the transillumination or the control group. The first three attempts were performed by pediatric residents, followed by three attempts by a neonatologist. The primary outcome was success at first attempt. Secondary comparisons included time to successful insertion and overall success rates of residents and neonatologists. RESULTS A total of 559 procedures were analyzed. The success rate at resident's first attempt was 44/93 (47%) with transillumination versus 44/90 (49%) without transillumination (p = 0.88) in the strata ≤1,500 g and 103/188 (55%) with transillumination versus 64/188 (34%) without transillumination in the strata >1,500 g (p < 0.001). The overall success rate for residents was 86% in the transillumination versus 73% in the control group in the strata >1,500 g (p = 0.003) but not different in the strata ≤1,500 g (78/93 [84%] vs. 72/90 [80%], p = 0.57). There was no effect when the experience level of residents exceeded 6 months. Neonatologists' overall success rate and time to successful cannulation did not differ significantly in both weight strata. CONCLUSION Transillumination improves the first-attempt success rate of peripheral vein cannulation performed by pediatric residents in neonates >1,500 g, while no benefit was found in infants ≤1,500 g.
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Affiliation(s)
- Samantha Hinterstein
- Department of General Pediatrics and Neonatology, Center for Pediatrics and Youth Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Harald Ehrhardt
- Department of General Pediatrics and Neonatology, Center for Pediatrics and Youth Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Klaus-Peter Zimmer
- Department of General Pediatrics and Neonatology, Center for Pediatrics and Youth Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | | | - Judith Kappesser
- Department of Psychology, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Christiane Hermann
- Department of Psychology, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Rahel Schuler
- Department of General Pediatrics and Neonatology, Center for Pediatrics and Youth Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Markus Waitz
- Department of General Pediatrics and Neonatology, Center for Pediatrics and Youth Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
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8
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Tian Y, Zhong Z, Dougarem D, Sun L. The ultrasound-guided versus standard technique for peripheral intravenous catheter placement by nurses: A systematic review and meta-analysis. Heliyon 2024; 10:e30582. [PMID: 38765178 PMCID: PMC11098833 DOI: 10.1016/j.heliyon.2024.e30582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 05/21/2024] Open
Abstract
Aim To comprehensively evaluate the efficacy of Ultrasound-guided technique for peripheral intravenous catheter placement by nurses in their daily practice. Background Peripheral intravenous catheter insertion is a common clinical procedure in healthcare settings. Ultrasound-guided peripheral intravenous placement has emerged in recent decades and was recognized as particularly useful in some specific patient groups. Methods Studies that had compared the ultrasound-guided and traditional approaches were eligible for inclusion and further analysis. The primary outcome was the success rate on the first intravenous insertion attempt. The secondary outcomes included the time needed for successful insertion, and the average number of attempts to establish the IV access. We systematically assess all studies using Cochrane Collaboration's Risk of Bias tool and the Newcastle-Ottawa Scale. We calculated the odds ratio and standardized mean difference with 95 % confidence intervals for the outcomes. Data were analyzed and visualized on Review Manager 5.3.4 and Stata 16.0. Results 23 studies were included (17 randomized controlled trials and six cohort studies) with a population of 2051 patients offered ultrasound-assisted technique and 2479 treated with the conventional approach for comparison. The former approach was associated with a higher success rate on the first attempt in comparison (OR = 2.95, 95 % CI: 1.86, 4.69). This technique also took less time and less acupuncture to patients' skin (SMD = -0.62, 95 % CI: 1.01, -0.23; SMD = -0.55, 95 % CI: 0.92, -0.18). In the sub-group analyses, children were more likely to benefit from ultrasound guided technique. Ultrasound guided technique demonstrated consistent and significant benefits in emergency clinical settings. Hospitals from different geographical locations exhibited similar trends in the three outcomes. Year of publication and study design revealed inconsistent and insignificant outcomes. Conclusions Ultrasound-guided technique can be a safer, faster, and more effective alternative to the traditional approach for nurses to establish intravenous access across different clinical settings and age groups.
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Affiliation(s)
- Yishu Tian
- Center for Reproductive Medicine, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Zixing Zhong
- Center for Reproductive Medicine, Department of Obstetrics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Djouhayna Dougarem
- Hospital of Obstetrics and Gynecology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Litao Sun
- Center for Reproductive Medicine, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
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Flores S, Su E, Moher JM, Adler AC, Riley AF. Point-of-Care-Ultrasound in Pediatrics: A Review and Update. Semin Ultrasound CT MR 2024; 45:3-10. [PMID: 38056790 DOI: 10.1053/j.sult.2023.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Point-of-Care-Ultrasound (POCUS) has encountered a tremendous expansion in patient care. POCUS has taken a central role during invasive procedures. POCUS has expanded to most subspecialties from adult to pediatric and neonatal health care. POCUS in pediatrics has also become part of specific critical situations such as myocardial function assessment during cardiac arrest, extracorporeal membrane oxygenation deployment and neurological evaluation. In this review we will go over the most important historical aspects of POCUS. We will also review important aspects of POCUS in the intensive care unit, cardiologist evaluation and in the emergency department among others.
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Affiliation(s)
- Saul Flores
- Department of Pediatrics, Division of Critical Care and Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
| | - Erik Su
- Department of Pediatrics, Division of Critical Care, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Justin M Moher
- Department of Pediatrics, Division of Emergency Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Adam C Adler
- Department of Anesthesiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Alan F Riley
- Department of Pediatrics, Division of Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
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10
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Popat A, Harikrishnan S, Seby N, Sen U, Patel SK, Mittal L, Patel M, Vundi C, Patel Y, Babita, Kumar A, Nakrani AA, Patel M, Yadav S. Utilization of Point-of-Care Ultrasound as an Imaging Modality in the Emergency Department: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e52371. [PMID: 38694948 PMCID: PMC11062642 DOI: 10.7759/cureus.52371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 05/04/2024] Open
Abstract
Point-of-care ultrasound (POCUS) is an imaging modality that has become a fundamental part of clinical care provided in the emergency department (ED). The applications of this tool in the ED have ranged from resuscitation, diagnosis, and therapeutic to procedure guidance. This review aims to summarize the evidence on the use of POCUS for diagnosis and procedure guidance. To achieve this, CrossRef, PubMed, Cochrane Library, Web of Science, and Google Scholar databases were extensively searched for studies published between January 2000 and November 2023. Additionally, the risk of bias assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies 2 (for studies on the diagnostic role of POCUS) and Cochrane Risk of Bias tool (for studies on the use of POCUS for procedure guidance). Furthermore, diagnostic accuracy outcomes were pooled using STATA 16 software (StatCorp., College Station, TX, USA), while outcomes related to procedure guidance were pooled using the Review Manager software. The study included 81 articles (74 evaluating the diagnostic application of POCUS and seven evaluating the use of POCUS in guiding clinical procedures). In our findings sensitivities and specificities for various conditions were as follows: appendicitis, 65% and 89%; hydronephrosis, 82% and 74%; small bowel obstruction, 93% and 82%; cholecystitis, 75% and 96%; retinal detachment, 94% and 91%; abscess, 95% and 85%; foreign bodies, 67% and 97%; clavicle fractures, 93% and 94%; distal forearm fractures, 97% and 94%; metacarpal fractures, 94% and 92%; skull fractures, 91% and 97%; and pleural effusion, 91% and 97%. A subgroup analysis of data from 11 studies also showed that the two-point POCUS has a sensitivity and specificity of 89% and 96%, while the three-point POCUS is 87% sensitive and 92% specific in the diagnosis of deep vein thrombosis. In addition, the analyses showed that ultrasound guidance significantly increases the overall success rate of peripheral venous access (p = 0.02) and significantly reduces the number of skin punctures (p = 0.01) compared to conventional methods. In conclusion, POCUS can be used in the ED to diagnose a wide range of clinical conditions accurately. Furthermore, it can be used to guide peripheral venous access and central venous catheter insertion.
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Affiliation(s)
- Apurva Popat
- Internal Medicine, Marshfield Clinic Health System, Marshfield, USA
| | | | - Niran Seby
- Internal Medicine, Tbilisi State Medical University, Tbilisi, GEO
| | - Udvas Sen
- Internal Medicine, Agartala Government Medical College, Agartala, IND
| | - Sagar K Patel
- Internal Medicine, Gujarat Adani Institute of Medical Sciences, Bhuj, IND
| | - Lakshay Mittal
- Internal Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Mitkumar Patel
- Internal Medicine, Mahatma Gandhi Mission (MGM) Medical College, Navi Mumbai, IND
| | - Charitha Vundi
- Internal Medicine, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, IND
| | - Yashasvi Patel
- Internal Medicine, Geetanjali Medical College and Hospital, Udaipur, IND
| | - Babita
- Internal Medicine, Uzhhorod National University, Uzhhorod, UKR
| | - Ashish Kumar
- General Practice, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Ahmedabad, IND
| | - Akash A Nakrani
- Internal Medicine, Gujarat Adani Institute of Medical Sciences, Surat, IND
| | - Mahir Patel
- Medical School, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND
| | - Sweta Yadav
- Internal Medicine, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Ahmedabad, IND
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Kameda T, Ishii H, Oya S, Katabami K, Kodama T, Sera M, Takei H, Taniguchi H, Nakao S, Funakoshi H, Yamaga S, Senoo S, Kimura A. Guidance for clinical practice using emergency and point-of-care ultrasonography. Acute Med Surg 2024; 11:e974. [PMID: 38933992 PMCID: PMC11201855 DOI: 10.1002/ams2.974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/11/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
Owing to the miniaturization of diagnostic ultrasound scanners and their spread of their bedside use, ultrasonography has been actively utilized in emergency situations. Ultrasonography performed by medical personnel with focused approaches at the bedside for clinical decision-making and improving the quality of invasive procedures is now called point-of-care ultrasonography (POCUS). The concept of POCUS has spread worldwide; however, in Japan, formal clinical guidance concerning POCUS is lacking, except for the application of focused assessment with sonography for trauma (FAST) and ultrasound-guided central venous cannulation. The Committee for the Promotion of POCUS in the Japanese Association for Acute Medicine (JAAM) has often discussed improving the quality of acute care using POCUS, and the "Clinical Guidance for Emergency and Point-of-Care Ultrasonography" was finally established with the endorsement of JAAM. The background, targets for acute care physicians, rationale based on published articles, and integrated application were mentioned in this guidance. The core points include the fundamental principles of ultrasound, airway, chest, cardiac, abdominal, and deep venous ultrasound, ultrasound-guided procedures, and the usage of ultrasound based on symptoms. Additional points, which are currently being considered as potential core points in the future, have also been widely mentioned. This guidance describes the overview and future direction of ultrasonography for acute care physicians and can be utilized for emergency ultrasound education. We hope this guidance will contribute to the effective use of ultrasonography in acute care settings in Japan.
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Affiliation(s)
- Toru Kameda
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Clinical Laboratory MedicineJichi Medical UniversityShimotsukeJapan
| | - Hiromoto Ishii
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency and Critical Care MedicineNippon Medical SchoolTokyoJapan
| | - Seiro Oya
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency MedicineShizuoka Medical CenterShizuokaJapan
| | - Kenichi Katabami
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency and Critical Care CenterHokkaido University HospitalSapporoJapan
| | - Takamitsu Kodama
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency and General Internal MedicineTajimi City HospitalTajimiJapan
| | - Makoto Sera
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency MedicineFukui Prefectural HospitalFukuiJapan
| | - Hirokazu Takei
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency MedicineHyogo Prefectural Kobe Children's HospitalKobeJapan
| | - Hayato Taniguchi
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Advanced Critical Care and Emergency CenterYokohama City University Medical CenterYokohamaJapan
| | - Shunichiro Nakao
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Hiraku Funakoshi
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency and Critical Care MedicineTokyo Bay Urayasu Ichikawa Medical CenterUrayasuJapan
| | - Satoshi Yamaga
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Radiation Disaster Medicine, Research Institute for Radiation Biology and MedicineHiroshima UniversityHiroshimaJapan
| | - Satomi Senoo
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency and Critical Care MedicineSaiseikai Yokohamashi Tobu HospitalYokohamaJapan
| | - Akio Kimura
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency and Critical CareCenter Hospital of the National Center for Global Health and MedicineTokyoJapan
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Stone R, Walker RM, Marsh N, Ullman AJ. Educational programs for implementing ultrasound guided peripheral intravenous catheter insertion in emergency departments: A systematic integrative literature review. Australas Emerg Care 2023; 26:352-359. [PMID: 37423812 DOI: 10.1016/j.auec.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Ultrasound-guided peripheral intravenous catheter insertion has been identified as an effective method to improve the success rate of cannulation, thereby improving patient experience. However, learning this new skill is complex, and involves training clinicians from a variety of backgrounds. The aim of this study was to appraise and compare literature on educational methods in the emergency setting used to support ultrasound guided peripheral intravenous catheter insertion by different clinicians, and how effective these current methods are. REVIEW METHODS A systematic integrative review was undertaken using Whittemore and Knafl's five stage approach. The Mixed Methods Appraisal Tool was used to assess the quality of the studies. RESULTS Forty-five studies met the inclusion criteria, with five themes identified. These were: the variety of educational methods and approaches; the effectiveness of the different educational methods; barriers and facilitators of education; clinician competency assessments and pathways; clinician confidence assessment and pathways. CONCLUSIONS This review demonstrates that a variety of educational methods are being used in successfully training emergency department clinicians in using ultrasound guidance for peripheral intravenous catheter insertion. Furthermore, this training has resulted in safer and more effective vascular access. However, it is evident that there is a lack of consistency of formalised education programs available. A standardised formal education program and increased availability of ultrasound machines in the emergency department will ensure consistent practices are maintained, retained, therefore leading to safer practice as well as more satisfied patients.
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Affiliation(s)
- Renee Stone
- Menzies Health Institute of Queensland, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan Campus, Brisbane, Queensland, Australia.
| | - Rachel M Walker
- Menzies Health Institute of Queensland, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Nicole Marsh
- Menzies Health Institute of Queensland, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Amanda J Ullman
- Menzies Health Institute of Queensland, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
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Fehr G, Rigali M, Weller G, Grap SM, Coleman M, Parekh U, Chinchilli VM, Dalal PG. Efficacy of Infrared Vein Visualization versus Standard Technique for Peripheral Venous Cannulation in Infant and Toddler Populations: A Randomized Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1652. [PMID: 37892315 PMCID: PMC10605772 DOI: 10.3390/children10101652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/24/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023]
Abstract
Establishing intravenous (IV) access in younger patient populations via the traditional cannulation technique for procedures requiring anesthesia is often challenging. Infrared (IR) vein visualization is a modality that aids venous cannulation; however, few reports of this technique exist in the infant and toddler population. The primary aim of this study was to compare the efficacy of IR vein visualization to the standard cannulation technique for obtaining peripheral IV access in infant and toddler populations. Following Institutional Review Board (IRB) approval and written informed consent, children were randomly assigned to either a standard cannulation technique group or an IR vein visualization device group for venous cannulation. The primary outcome variable was the success rate of IV cannulation, and the secondary variables were the total number of attempts and the time to successful cannulation. No difference was noted between either group for first-attempt success rate (standard versus IR: 61.25% vs. 54.4%; p = 0.4) or time to establish IV cannulation (standard versus IR: median [interquartile range], 40 s [24-120] vs. 53 s [26-106]; p = 0.55). The anesthesiologist's grading of the anticipated difficulty of IV cannulation was a significant predictor of cannulation success (p = 0.0016). Our study demonstrated no significant benefit in utilizing the IR vein visualization device in terms of the overall success rate, number of attempts, and time to establish successful IV cannulation when compared to the standard technique. However, in difficult IV access situations, this device proved to be a valuable rescue adjunct.
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Affiliation(s)
- Graham Fehr
- Department of Anesthesiology, Children’s Hospital of King’s Daughters, Norfolk, VA 23507, USA;
| | - Marisa Rigali
- Department of Anesthesiology, Virginia Commonwealth School of Medicine, Richmond, VA 23219, USA;
| | - Gregory Weller
- Department of Anesthesiology, Penn State Health, Hershey, PA 17033, USA; (G.W.); (S.M.G.); (M.C.); (U.P.)
| | - Shannon M. Grap
- Department of Anesthesiology, Penn State Health, Hershey, PA 17033, USA; (G.W.); (S.M.G.); (M.C.); (U.P.)
| | - Melissa Coleman
- Department of Anesthesiology, Penn State Health, Hershey, PA 17033, USA; (G.W.); (S.M.G.); (M.C.); (U.P.)
| | - Uma Parekh
- Department of Anesthesiology, Penn State Health, Hershey, PA 17033, USA; (G.W.); (S.M.G.); (M.C.); (U.P.)
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA;
| | - Priti G. Dalal
- Department of Anesthesiology, Penn State Health, Hershey, PA 17033, USA; (G.W.); (S.M.G.); (M.C.); (U.P.)
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Takeshita J, Nakayama Y, Tachibana K, Nakajima Y, Shime N. Ultrasound-Guided Short-Axis Out-of-Plane Approach With or Without Dynamic Needle-Tip Positioning for Peripheral Venous Catheterization in Pediatric Patients: A Systematic Review With Network Meta-Analysis. J Cardiothorac Vasc Anesth 2023; 37:2057-2064. [PMID: 37217420 DOI: 10.1053/j.jvca.2023.04.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To compare the efficacy of the ultrasound-guided approach with and without dynamic needle-tip positioning and the palpation technique regarding success for peripheral venous catheterization in children. DESIGN A systematic review with network meta-analysis. SETTING Databases of MEDLINE (via PubMed) and Cochrane Central Register of Controlled Trials. PARTICIPANTS Patients (<18 years) undergoing peripheral venous catheter insertion. INTERVENTIONS Randomized clinical trials were included to compare the following techniques: the ultrasound-guided short-axis out-of-plane approach with dynamic needle-tip positioning, the approach without dynamic needle-tip positioning, and the palpation technique. MEASUREMENTS AND MAIN RESULTS The outcomes were first-attempt and overall success rates. Eight studies were included in the qualitative analyses. According to the estimate of network comparison, dynamic needle-tip positioning was associated with higher first-attempt (risk ratio [RR] 1.67; 95% CI 1.33-2.09) and overall success rates (RR 1.25; 95% CI 1.08-1.44) than palpation. The approach without dynamic needle-tip positioning was not associated with higher first-attempt (RR 1.17; 95% CI 0.91-1.49) and overall success rates (RR 1.10; 95% CI 0.90-1.33) than palpation. Compared to the approach without dynamic needle-tip positioning, dynamic needle-tip positioning was associated with a higher first-attempt success rate (RR 1.43; 95% CI 1.07-1.92), but not a higher overall success rate (RR 1.14; 95% CI 0.92-1.41). CONCLUSIONS Dynamic needle-tip positioning is efficacious for peripheral venous catheterization in children. It would be better to include dynamic needle-tip positioning for the ultrasound-guided short-axis out-of-plane approach.
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Affiliation(s)
- Jun Takeshita
- Department of Anesthesiology, Osaka Prefectural Hospital Organization, Osaka Women's and Children's Hospital, Osaka, Japan.
| | - Yoshinobu Nakayama
- Molecular, Cellular and Biomedical Sciences Department, CUNY School of Medicine, City College of New York, New York, USA
| | - Kazuya Tachibana
- Department of Anesthesiology, Osaka Prefectural Hospital Organization, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Yasufumi Nakajima
- Department of Anesthesiology and Intensive Care, Kinki University Faculty of Medicine, Osaka, Japan; Outcomes Research Consortium, Cleveland, Ohio
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
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15
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Schults JA, Marsh N, Ullman AJ, Kleidon TM, Ware RS, Byrnes J, Young E, Hall L, Keijzers G, Cullen L, Calleja P, McTaggart S, Peters N, Watkins S, Corley A, Brown C, Lin Z, Williamson F, Burgess L, Macfarlane F, Cooke M, Battley C, Rickard CM. Improving difficult peripheral intravenous access requires thought, training and technology (DART 3): a stepped-wedge, cluster randomised controlled trial protocol. BMC Health Serv Res 2023; 23:587. [PMID: 37286977 DOI: 10.1186/s12913-023-09499-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/04/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) are the most used invasive medical device in healthcare. Yet around half of insertion attempts are unsuccessful leading to delayed medical treatments and patient discomfort of harm. Ultrasound-guided PIVC (USGPIVC) insertion is an evidence-based intervention shown to improve insertion success especially in patients with Difficult IntraVenous Access (BMC Health Serv Res 22:220, 2022), however the implementation in some healthcare settings remains suboptimal. This study aims to co-design interventions that optimise ultrasound guided PIVC insertion in patients with DIVA, implement and evaluate these initiatives and develop scale up activities. METHODS A stepped-wedge cluster randomized controlled trial will be conducted in three hospitals (two adult, one paediatric) in Queensland, Australia. The intervention will be rolled out across 12 distinct clusters (four per hospital). Intervention development will be guided by Michie's Behavior Change Wheel with the aim to increase local staff capability, opportunity, and motivation for appropriate, sustainable adoption of USGPIVC insertion. Eligible clusters include all wards or departments where > 10 PIVCs/week are typically inserted. All clusters will commence in the control (baseline) phase, then, one cluster per hospital will step up every two months, as feasible, to the implementation phase, where the intervention will be rolled out. Implementation strategies are tailored for each hospital by local investigators and advisory groups, through context assessments, staff surveys, and stakeholder interviews and informed by extensive consumer interviews and consultation. Outcome measures align with the RE-AIM framework including clinical-effectiveness outcomes (e.g., first-time PIVC insertion success for DIVA patients [primary outcome], number of insertion attempts); implementation outcomes (e.g., intervention fidelity, readiness assessment) and cost effectiveness outcomes. The Consolidated Framework for Implementation Research framework will be used to report the intervention as it was implemented; how people participated in and responded to the intervention; contextual influences and how the theory underpinning the intervention was realised and delivered at each site. A sustainability assessment will be undertaken at three- and six-months post intervention. DISCUSSION Study findings will help define systematic solutions to implement DIVA identification and escalation tools aiming to address consumer dissatisfaction with current PIVC insertion practices. Such actionable knowledge is critical for implementation of scale-up activities. TRIAL REGISTRATION Prospectively registered (Australian and New Zealand Clinical Trials Registry; ACTRN12621001497897).
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Affiliation(s)
- Jessica A Schults
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia.
- Centre for Clinical Research, The University of Queensland, Brisbane, Australia.
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Australia.
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia.
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia.
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia.
| | - Nicole Marsh
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
| | - Amanda J Ullman
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- Children's Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Tricia M Kleidon
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Robert S Ware
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Joshua Byrnes
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
- Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia
| | - Emily Young
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Lisa Hall
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Gerben Keijzers
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
- Department of Emergency Medicine, Gold Coast University Hospital Southport, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Louise Cullen
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Pauline Calleja
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
- School of Nursing, Midwifery & Social Science, Central Queensland University, Queensland, Australia
| | - Steven McTaggart
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- Children's Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Nathan Peters
- Faculty of Medicine, University of Queensland, Queensland, Australia
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Stuart Watkins
- Department of Emergency Medicine, Gold Coast University Hospital Southport, Queensland, Australia
| | - Amanda Corley
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
| | - Christine Brown
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Zhen Lin
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Queensland, Australia
| | - Frances Williamson
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Queensland, Australia
- Jamieson Trauma Institute, Herston, QLD, Australia
| | - Luke Burgess
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Fiona Macfarlane
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Marie Cooke
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
| | - Callan Battley
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- Children's Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Claire M Rickard
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Centre for Clinical Research, The University of Queensland, Brisbane, Australia
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Australia
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
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16
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Dhochak N, Lodha R. Difficult Intravenous Cannulation in Children: Role of Assisting Devices. Indian J Pediatr 2023; 90:533-534. [PMID: 36988822 DOI: 10.1007/s12098-023-04553-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Nitin Dhochak
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Mahmoud A, El-Sharkawy YH. Quantitative phase analysis and hyperspectral imaging for the automatic identification of veins and blood perfusion maps. Photodiagnosis Photodyn Ther 2023; 42:103307. [PMID: 36709016 DOI: 10.1016/j.pdpdt.2023.103307] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Medical workers commonly physically identify subcutaneous veins to locate a suitable vesselto implant a catheter for drug administration or blood sample. The general rule of thumb is to locate a big, clean vein that will allow the medication to readily pass within the intended blood vessel. Peripheral problematic venous access happens when a patient's veins are difficult to palpate because of factors like dark skin tone, edema or excess tissue. The ability to see how the vasculature changes to support the therapeutic methods without damaging the surrounding tissue is another challenge. MATERIALS AND METHODS Hyperspectral imaging (HI) is a developing technique with several potential uses in medicine. Using its spectroscopic data, veins and arterioles could be noninvasively detected and discriminated. It is frequently important to use quantitative phase analysis for vein localization. To assess hyperspectral image data for the detection of both veins and peripheral arteries, we suggest using an advanced image processing and classification algorithm based on the phase information related to the index of refraction change and associated scattering. We show that this need may be satisfied using quantitative phase imaging of forearm skin tissue at different depths. RESULTS To demonstrate the variations in the diffuse reflectance characteristics between skin surface and veins, phase resolved pictures were successfully produced for twelve volunteers using our imaging methodology. We found that the skin surface details are completely apparent at the unique wavelength of 441 nm. The 500-nm wavelength was the most efficient for grouping peripheral arteries and illuminating the blood perfusion maps. Using our HI experimental setup and our phase imaging procedure on the 600 nm and 650 nm visible spectral pictures, we were able to properly describe the vein map. This spectral area may be utilized as a vein locator marker which could approximately reach till 3 mm depth under skin surface. CONCLUSIONS Initial findings suggested that our imaging technique would be able to assist medical examiners in safely assessing the veins and arteriole's locations automatically without exposing the skin to infrared radiation. Meanwhile, our pilot research in this work to determine the best spectral wavelengths for localizing veins and mapping blood perfusion using our phase analysis imaging strategy with the HI camera. By substituting the HI camera with a custom conventional RGB camera that only functions at specific wavelengths during the discovering of blood perfusion locations or prior to intravenous catheterization, a distinctive and efficient system for precise identification may be developed to serve in the field of the vascular therapeutic methods.
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Affiliation(s)
- Alaaeldin Mahmoud
- PhD in Optoelectronics Engineering, Head of Optoelectronics and Automatic Control Systems Department, Military Technical College, Kobry El-Kobba, Cairo, Egypt.
| | - Yasser H El-Sharkawy
- Professor in Optoelectronics and Automatic Control Systems Department, Military Technical Collage, Kobry Elkoba, Cairo, Egypt
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Ballard HA, Rivera A, Tsao M, Phillips M, Robles A, Hajduk J, Feinglass J, Barsuk JH. Use of an ultrasound-guided intravenous catheter insertion simulation-based mastery learning curriculum to improve paediatric anaesthesia care. BJA OPEN 2022; 4:100101. [PMID: 37588791 PMCID: PMC10430828 DOI: 10.1016/j.bjao.2022.100101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/06/2022] [Indexed: 08/18/2023]
Abstract
Background We previously showed that an ultrasound-guided i.v. catheter insertion (USGIV) simulation-based mastery learning (SBML) curriculum improves the simulated USGIV skills of paediatric anaesthesiologists. It remains unclear if improvements in simulated USGIV skills translate to improved patient care. Methods A cohort study was conducted from August 2018 to August 2020 to evaluate paediatric anaesthesiologists' USGIV performance in the operating theatre before and after they participated in the USGIV SBML curriculum. Paediatric anaesthesiologists' use of ultrasound for successful i.v. insertion and first-attempt i.v. insertion success rate with ultrasound were compared before and after training. Results Twenty-nine paediatric anaesthesiologists completed training. Unadjusted analysis showed a significant increase in the percentage of i.v. catheters inserted with ultrasound for successful i.v. catheter insertion (9.5-14.5%; P<0.001) and first i.v. catheter insertion attempt success with ultrasound (5.5-8.9%; P<0.001) from before to after training. Multivariable regression analysis showed higher odds of ultrasound use for a successful i.v. catheter attempt (1.79; 95% confidence interval [CI]: 1.11-2.90; P=0.018) and first-attempt success with ultrasound (4.11; 95% CI: 2.02-8.37; P<0.001) after training. Conclusions After completing the USGIV SBML curriculum, paediatric anaesthesiologists increased their ultrasound use for successful i.v. catheter insertion and first-attempt success rate with ultrasound for patients in the operating theatre.
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Affiliation(s)
- Heather A. Ballard
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Adovich Rivera
- Institute of Public Health, Division of Health Services Outcomes Research, USA
| | - Michelle Tsao
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Mitch Phillips
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Alison Robles
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - John Hajduk
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Joe Feinglass
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey H. Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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19
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Berlanga-Macías C, Díez-Fernández A, Martínez-Hortelano JA, Sequí-Domínguez I, Saz-Lara A, Pozuelo-Carrascosa D, Martínez-Vizcaíno V. Ultrasound-guided versus traditional method for peripheral venous access: an umbrella review. BMC Nurs 2022; 21:307. [DOI: 10.1186/s12912-022-01077-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
Short peripheral catheters (SPC) insertion technique has a high failure rate, one of the reasons why the ultrasound (US)-guided method has been proposed as a valid alternative to traditional technique in SPC insertion. This umbrella review aims to synthesize the available evidence comparing the US-guided method with the traditional method on SPC insertion in terms of effectiveness, safety and patient satisfaction.
Methods
An umbrella review addressing the comparison between US-guided versus traditional method for SPC insertion in which only systematic reviews of all comparative study designs were eligible was carried out. Previous systematic reviews and meta-analyses were systematically searched in MEDLINE, EMBASE, Web of Science and Cochrane Library. Methodological quality was assessed with AMSTAR-2 tool. The quality of evidence per association was assessed using the GRADE criteria and was stablished as high, moderate, low and very low.
Results
Twelve systematic reviews with a range of 75–1860 patients were included. Moderate certainty evidence supports the positive effect of US-guided method on first-attempt success rate and number of attempts. There is moderate certainty evidence that US-guided method does not reduce the time spent in SPC insertion. Low certainty evidence supports that US-guided method improves both overall success rates and patient satisfaction. Emergency department was the main hospital department where these findings were reported.
Conclusions
The best current evidence indicates that US-guided method for SPC insertion is postulated as a valid alternative for both adult and pediatric population, especially in patients with difficult venous access and in hospital departments where optimal vascular access in the shortest time possible is critical.
Trial registration
PROSPERO: CRD42021290824.
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20
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Ballard HA, Hajduk J, Cheon EC, King MR, Barsuk JH. Clinical and demographic factors associated with pediatric difficult intravenous access in the operating room. Paediatr Anaesth 2022; 32:792-800. [PMID: 35293066 PMCID: PMC9310763 DOI: 10.1111/pan.14438] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pediatric intravenous catheter insertion can be difficult in the operating room due to the technical challenges of small diameter vessels and the need to rapidly gain intravenous access in anesthetized children. Few studies have examined factors associated with difficult vascular access in the operating room, especially accounting for the increased possibility to use ultrasound guidance. AIMS The primary aim of the study was to identify factors associated with pediatric difficult vascular access in the operating room. Our primary hypothesis was that Black race, Hispanic ethnicity, and ultrasound use would be associated with pediatric difficult vascular access. METHODS We performed a retrospective analysis of prospectively collected data from a cohort of pediatric patients who had intravenous catheters inserted in the operating room at an academic tertiary care children's hospital from March 2020 to February 2021. We measured associations among patients who were labeled as having difficult vascular access (>2 attempts at access) with demographic, clinical, and hospital factors. RESULTS 12 728 intravenous catheter insertions were analyzed. Multivariable analysis showed significantly higher odds of difficult vascular access with Black non-Hispanic race (1.43, 95% CI: 1.06-1.93, p = .018), younger age (0.93, 95% CI: 0.89-0.98, p = .005), overweight (1.41, 95% CI: 1.04-1.90, p = .025) and obese body mass index (1.56, 95% 95% CI: 1.12-2.17, p = .008), and American Society of Anesthesiologists physical status III (1.54, 95% CI:1.11-2.13, p = .01). The attending anesthesiologist compared to all other practitioners (certified registered nurse anesthetist: (0.41, 95% CI: 0.31-0.56, p < .001, registered nurse: 0.25, 95% CI: 0.13-0.48, p < .001, trainee: 0.21, 95% CI: 0.17-0.28, p-value <.001 with attending as reference variable) and ultrasound use (2.61, 95% CI: 1.85-3.69, p < .001) were associated with successful intravenous catheter placement. CONCLUSIONS Black non-Hispanic race/ethnicity, younger age, obese/overweight body mass index, American Society of Anesthesiologists physical status III, and ultrasound were all associated with pediatric difficult vascular access in the operating room.
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Affiliation(s)
- Heather A. Ballard
- Department of Pediatric AnesthesiologyAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - John Hajduk
- Department of Pediatric AnesthesiologyAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - Eric C. Cheon
- Department of Pediatric AnesthesiologyAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - Michael R. King
- Department of Pediatric AnesthesiologyAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - Jeffrey H. Barsuk
- Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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21
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Kleidon TM, Schults J, Paterson R, Rickard CM, Ullman AJ. Comparison of ultrasound-guided peripheral intravenous catheter insertion with landmark technique in paediatric patients: A systematic review and meta-analysis. J Paediatr Child Health 2022; 58:953-961. [PMID: 35441751 PMCID: PMC9321813 DOI: 10.1111/jpc.15985] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/06/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Paediatric peripheral intravenous catheter (PIVC) insertion using traditional landmark insertion technique can be difficult. AIM To systematically review the evidence comparing landmark to ultrasound guidance for PIVC insertion in general paediatric patients. STUDY DESIGN Cochrane methodology to systematically search for randomised controlled trials comparing landmark to ultrasound-guided PIVC insertion. DATA SOURCES Cochrane Central Register of Controlled Trials, US National Library of Medicine, Cumulative Index to Nursing and Allied Health, Embase. DATA EXTRACTION English-language, paediatric trials published after 2000, reporting first-attempt insertion success, overall PIVC insertion success, and/or time to insert were included. Central venous, non-venous and trials including only difficult intravenous access were excluded. Data were independently extracted and critiqued for quality using GRADE by three authors, and analysed using random effects, with results expressed as risk ratios (RR), mean differences (MD) and 95% confidence intervals (CI). Registration (CRD42020175314). RESULTS Of 70 titles identified, 5 studies (995 patients; 949 PIVCs) were included. There was no evidence of an effect of ultrasound guidance, compared to landmark, for first-attempt insertion success (RR 1.27; 95% CI 0.90-1.78; I2 = 88%; moderate quality evidence), overall insertion success (RR 1.14; 95% CI 0.90-1.44; I2 = 82%; low quality evidence), or time to insertion (mean difference -3.03 min; 95% CI -12.73 to 6.67; I2 = 92%; low quality evidence). LIMITATIONS Small sample sizes, inconsistent outcomes and definitions in primary studies precluded definitive conclusions. CONCLUSIONS Large clinical trials are needed to explore the effectiveness of ultrasound guidance for PIVC insertion in paediatrics. Specifically, children with difficult intravenous access might benefit most from this technology.
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Affiliation(s)
- Tricia M Kleidon
- Department of AnaesthesiaQueensland Children's HospitalBrisbaneQueenslandAustralia
- Alliance for Vascular Access Teaching and Research GroupMenzies Health Institute QueenslandGold CoastQueenslandAustralia
- School of Nursing and MidwiferyGriffith UniversityBrisbaneQueenslandAustralia
- School of Nursing, Midwifery and Social WorkThe University of QueenslandSt. LuciaQueenslandAustralia
| | - Jessica Schults
- Department of AnaesthesiaQueensland Children's HospitalBrisbaneQueenslandAustralia
- Alliance for Vascular Access Teaching and Research GroupMenzies Health Institute QueenslandGold CoastQueenslandAustralia
- School of Nursing and MidwiferyGriffith UniversityBrisbaneQueenslandAustralia
- School of Nursing, Midwifery and Social WorkThe University of QueenslandSt. LuciaQueenslandAustralia
| | - Rebecca Paterson
- Department of AnaesthesiaQueensland Children's HospitalBrisbaneQueenslandAustralia
- Alliance for Vascular Access Teaching and Research GroupMenzies Health Institute QueenslandGold CoastQueenslandAustralia
- Faculty of MedicineThe University of QueenslandSt. LuciaQueenslandAustralia
| | - Claire M Rickard
- Department of AnaesthesiaQueensland Children's HospitalBrisbaneQueenslandAustralia
- Alliance for Vascular Access Teaching and Research GroupMenzies Health Institute QueenslandGold CoastQueenslandAustralia
- School of Nursing and MidwiferyGriffith UniversityBrisbaneQueenslandAustralia
- School of Nursing, Midwifery and Social WorkThe University of QueenslandSt. LuciaQueenslandAustralia
| | - Amanda J Ullman
- Department of AnaesthesiaQueensland Children's HospitalBrisbaneQueenslandAustralia
- Alliance for Vascular Access Teaching and Research GroupMenzies Health Institute QueenslandGold CoastQueenslandAustralia
- School of Nursing and MidwiferyGriffith UniversityBrisbaneQueenslandAustralia
- School of Nursing, Midwifery and Social WorkThe University of QueenslandSt. LuciaQueenslandAustralia
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Heydinger G, Shafy SZ, O’Connor C, Nafiu O, Tobias JD, Beltran RJ. Characterization of the Difficult Peripheral IV in the Perioperative Setting: A Prospective, Observational Study of Intravenous Access for Pediatric Patients Undergoing Anesthesia. Pediatric Health Med Ther 2022; 13:155-163. [PMID: 35548373 PMCID: PMC9081190 DOI: 10.2147/phmt.s358250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Various criteria exist for defining difficult intravenous access (DIVA) in infants and children. The current study evaluated the factors associated with DIVA in a prospective cohort of over 1000 infants and children presenting for anesthetic care. Methods This was a prospective, observational study of patients aged 0 to 18 years undergoing elective surgical or radiologic procedures under general anesthesia. Prior to the initial attempt at peripheral intravenous (PIV) cannulation, the anticipated difficulty of PIV catheter placement was determined by the provider using a visual analogue scale (VAS) from 1 to 10. The number of attempts was recorded as well as the time required to achieve PIV access. DIVA was defined as requiring three or more attempts. After successful cannulation, the actual difficulty of the PIV placement was assessed by the provider and recorded using the same VAS. Patient characteristics, including age, race, body mass index (BMI), American Society of Anesthesiologists (ASA) physical classification, and history of difficult PIV placement, were evaluated as covariates. Results In our cohort of 1002 pediatric patients, 78% of patients were successfully cannulated in a single attempt and 91% of patients were successfully cannulated in two or fewer attempts. Factors associated with requiring three or more PIV attempts included younger age (OR 8.73; 95% CI: 3.38, 22.6 for age <1 year and OR 4.93; 95% CI: 2.05, 11.8 for age 1-3 years), higher ASA physical classification (OR 1.95; 95% CI: 1.10, 3.46 for ASA II), and prior history of difficult PIV placement (OR 3.46; 95% CI: 1.70, 7.08). BMI, racial category or gender were not independent predictors of DIVA. Conclusion We found that approximately 9% of patients required three or more attempts at IV placement in the operating room. Patients that required multiple PIV attempts were more likely to be younger, have a higher ASA classification or a history of difficult PIV placement.
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Affiliation(s)
- Grant Heydinger
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Shabana Z Shafy
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Colin O’Connor
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Olubukola Nafiu
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ralph J Beltran
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
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23
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Mitchell EO, Jones P, Snelling PJ. Ultrasound for Pediatric Peripheral Intravenous Catheter Insertion: A Systematic Review. Pediatrics 2022; 149:186816. [PMID: 35445257 DOI: 10.1542/peds.2021-055523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Establishing peripheral intravenous catheter (PIVC) access in infants and children is a common procedure but can be technically difficult. The primary objective was to determine the effect ultrasound had on first attempt PIVC insertion success rates in the pediatric population. Secondary objectives included overall success rates and subgroups analyses. METHODS A systematic review of articles using Medline, Embase, CENTRAL, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. Randomized trials evaluating ultrasound-guided PIVC insertion against the landmark approach in pediatric patients who reported at least 1 outcome of success rate (first attempt or overall) were included. Methodological quality of the literature was assessed using the Revised Cochrane risk-of-bias tool for randomized trials. A meta-analysis using a random-effects model was performed. RESULTS Nine studies with 1350 patients, from a total of 1033 studies, were included for analysis. Ultrasound showed a statistically significant improvement in PIVC insertion success on first attempt in 5 of 8 studies, with an overall success rate of 78% in the ultrasound group and 66% in the control group. The secondary outcome of overall success was improved by ultrasound in studies that allowed ≥3 attempts (pooled OR 3.57, 95% CI 2.05 to 6.21, P < .001, I2 = 0.0%). CONCLUSIONS This systematic review suggested that ultrasound improves pediatric PIVC first pass and overall success rates. Subgroup analysis showed improvement in PIVC success rates for patients with difficult intravenous access and a single operator, dynamic, short-axis ultrasound technique.
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Affiliation(s)
- Evan O Mitchell
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia.,Departments of Pediatrics
| | - Philip Jones
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia.,Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia.,Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Peter J Snelling
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia.,Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia.,Sonography Innovation and Research (Sonar) Group, Queensland, Australia.,Child Health Research Centre, University of Queensland, Queensland, Australia
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24
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de la Vieja-Soriano M, Blanco-Daza M, Macip-Belmonte S, Dominguez-Muñoz M, López-Sánchez E, Pérez-Pérez E. Difficult intravenous access in a paediatric intensive care unit. ENFERMERIA INTENSIVA 2022; 33:67-76. [PMID: 35562260 DOI: 10.1016/j.enfie.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 03/22/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Multiple attempts during peripheral cannulation can have major consequences for patients, relatives, and healthcare professionals, therefore we set out to determine the extent of this problem in a paediatric intensive care unit (PICU). OBJECTIVES The main aim was to describe peripheral venous catheter (PVC) and peripherally inserted central catheter (PICC) cannulation in children in the PICU. Secondary objectives were to determine the success rate of the first cannulation attempt, to quantify patients with difficult venous access (DVA), and to explore the association between DVA and sociodemographic, technique and nursing-related characteristics. METHOD A cross-sectional descriptive study. Consecutive sampling was used to recruit patients aged 0-18 years admitted to the PICU who required peripheral venous cannulation. An ad hoc questionnaire was used for this purpose, including the presence of DVA as an independent variable. RESULTS A total of 163 venous cannulations were reported. A total of 55.8% (91) were performed in patients under 1 year of age. Of these, 38.7% (63) were successful on the first attempt and 36.8% (60) had DVA. When there was DVA, 85% (51) of patients had complications, median time to cannulation by short CVP was 30 minutes [15-53] and 2 or more nurses were required on 80% (48) of occasions. CONCLUSIONS We found a low success rate at first attempt and a high proportion of DVA. More nurses and time were employed during cannulation and complications increased if the patient had DVA. A statistically significant association was found between DVA and age, weight, poor perfusion, veins that were neither visible nor palpable, DIVA score ≥ 4, history of difficult intravenous access, complications, number of nurses and time spent.
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Affiliation(s)
- M de la Vieja-Soriano
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - M Blanco-Daza
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - S Macip-Belmonte
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Dominguez-Muñoz
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E López-Sánchez
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E Pérez-Pérez
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, Spain
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25
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Bhargava V, Su E, Haileselassie B, Davis D, Steffen KM. Ultrasound education improves safety for peripheral intravenous catheter insertion in critically ill children. Pediatr Res 2022; 91:1057-1063. [PMID: 34075190 DOI: 10.1038/s41390-021-01568-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/05/2021] [Accepted: 04/05/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Difficulty in obtaining peripheral vascular access is a common problem in patients admitted to the pediatric intensive care unit (PICU). The use of ultrasound guidance can improve the overall success in obtaining vascular access. This study evaluated the success and longevity of PIV placement by nurses pre- and post-implementation of an USGPIV curriculum. METHODS PICU nurses participated in a prospective quality improvement study. Each participating nurse attempted 10 PIVs by using landmark (LM) methods. The same nurses then received individual instruction in an USGPIV placement curriculum. Following the educational intervention, each nurse attempted 10 USGPIVs. RESULTS A total of 150 LM PIVs and 143 USGPIVs were attempted. The first stick success in the post-intervention (USGPIV) group was 85.9% compared to 47.3% in the pre-intervention (LM) group (p < 0.001). Overall success was also superior in the USGPIV group (94.3 versus 57.3%, respectively; p < 0.001). PIVs placed by US lasted longer with a median survival time of 4 ± 3.84 days versus 3 ± 3.51 days for LM PIVs (p < 0.050, log-rank test). CONCLUSIONS Successful implementation of a standardized curriculum for USGPIV placement for PICU nurses improves first stick, overall success, and longevity of PIV catheter placement. IMPACT An ultrasound-guided IV curriculum can be successfully implemented resulting in increased first stick success and increased longevity. Registered nurses can be trained in placement of ultrasound-guided IV placement. This study provides a training curriculum for ultrasound-guided IV placement that can be applied to other settings or institutions.
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Affiliation(s)
- Vidit Bhargava
- Department of Pediatrics, Division of Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Erik Su
- Department of Pediatrics, Division of Critical Care Medicine, McGovern Medical School, Houston, TX, USA
| | - Bereketeab Haileselassie
- Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA, USA.,Department of Pediatrics, Division of Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Daniel Davis
- Department of Pediatrics, Division of Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Katherine M Steffen
- Department of Pediatrics, Division of Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Wang S, Xia D, Zhang Z, Zhang J, Meng W, Zhang Y, Xu S. Mapping Trends and Hotspots Regarding the Use of Ultrasound in Emergency Medicine: A Bibliometric Analysis of Global Research. Front Public Health 2022; 9:764642. [PMID: 35004578 PMCID: PMC8739757 DOI: 10.3389/fpubh.2021.764642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: Diagnostic tools in emergency medicine have been widely studied. As a non-invasive and quick tool, ultrasound plays a role in the field of emergency medicine. Thus, it is significant to understand the global scientific output of this topic. An analysis of publications on the use of ultrasound in emergency medicine over the past decade was performed and summarized to track the current hotspots and highlight future directions. Methods: Globally relevant publications on ultrasound in emergency medicine from 2009 to 2020 were extracted from the Web of Science collection database. VOSviewer software and CiteSpace were employed to visualize and predict the trends in the research on the topic. Results: The overall volume of global publications is on the rise; furthermore, the United States published the most publications in this field and had the most citations and H-index. University of California at San Francisco in the United States has most publications in terms of institutions. The American Journal of Emergency Medicine published the most papers related to ultrasound in emergency medicine in terms of journals. Pulmonary embolism was once the main research direction, and importantly, “point-of-care ultrasound” was determined to be a new research hotspot. Conclusion: Altogether, the number of publications on ultrasound in emergency medicine will rise in the future. In addition, the findings reported here shed new light on the major progress on ultrasound in emergency medicine, which may be mutually cooperative in various fields. Moreover, this bibliometric study provides further indications for the topic of “point-of-care ultrasound”.
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Affiliation(s)
- Sheng Wang
- Department of Emergency, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Demeng Xia
- Department of Emergency, Changhai Hospital, Naval Medical University, Shanghai, China.,Health Clinic, People's Liberation Army Unit 91666, Zhoushan, China
| | - Zhentao Zhang
- Department of Clinical Medicine, Naval Medical University, Shanghai, China
| | - Jingli Zhang
- Department of Neurology Rehabilitation, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, China
| | - Wenhao Meng
- Department of Clinical Medicine, Wei Fang Medical University, Wei Fang, China
| | - Yanping Zhang
- Nanjing Comprehensive Stroke Center, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Shuogui Xu
- Department of Emergency, Changhai Hospital, Naval Medical University, Shanghai, China
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27
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McGinness A, Lin-Martore M, Addo N, Shaahinfar A. The unmet demand for point-of-care ultrasound among general pediatricians: a cross-sectional survey. BMC MEDICAL EDUCATION 2022; 22:7. [PMID: 34980087 PMCID: PMC8722332 DOI: 10.1186/s12909-021-03072-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is a noninvasive bedside tool with many pediatric applications but is not currently a formal part of pediatric training and practice. Formal surveys of general pediatricians regarding POCUS training are lacking. We aimed to quantify the baseline ultrasound experience and training needs of general pediatricians and pediatric residents across different practice settings. METHODS In 2020, we sent an online survey to 485 current faculty, residents, and graduates from an urban pediatric academic medical center in Northern California. Pediatric subspecialists were excluded. Survey questions about baseline experience, comfort, and perceived usefulness of 20 common POCUS applications were developed by two POCUS experts using existing literature. Chi-squared analysis was used to compare residents versus attendings and to compare attendings practicing in inpatient versus outpatient versus mixed settings. RESULTS Response rate was 20% (98/485). Compared to attendings (n = 73), residents (n = 25) endorsed more exposure to POCUS in medical school (32% vs 5%, p = 0.003) and residency (12% vs 5%, p = 0.003). Respondents endorsed low comfort with POCUS (mean 1.3 out of 5 on Likert scale). Of 20 procedural and diagnostic applications, respondents identified abscess drainage, bladder catheterization, soft tissue, neck, advanced abdominal, and constipation as most useful. Overall, 50% of pediatricians (and 70% of pediatric residents) responded that there were opportunities to use POCUS multiple times a week or more in their clinical practice. CONCLUSIONS There is an unmet demand for POCUS training among general pediatricians and trainees in our study. Although the majority of respondents were not POCUS users, our results could guide future efforts to study the role of POCUS in general pediatrics and develop pediatric curricula.
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Affiliation(s)
- Anelah McGinness
- Department of Graduate Medical Education, PGY-3 resident, University of California San Francisco Benioff Children’s Hospital Oakland, 747 52nd Street, Suite 245, Oakland, CA 94609 USA
| | - Margaret Lin-Martore
- Departments of Emergency Medicine and Pediatrics, University of California San Francisco, 5150 16th St, Box 0632, San Francisco, CA 94143 USA
| | - Newton Addo
- Departments of Medicine and Emergency Medicine, 1001 Potrero Ave, Box 1220, San Francisco, CA 94143 USA
| | - Ashkon Shaahinfar
- Departments of Emergency Medicine and Pediatrics, University of California San Francisco Benioff Children’s Hospital Oakland, University of California San Francisco, 747 52nd Street, ED Trailer 3, Oakland, CA 94609 USA
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Adrian RJ, Choi A, Lamba S, Ostrovsky I, Ramdin C, Traba C, Chen S, Sudyn A, Alerhand S. Teaching Module on Ultrasound-Guided Venous Access Using a Homemade Gel Model for Fourth-Year Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2022; 18:11222. [PMID: 35136837 PMCID: PMC8807663 DOI: 10.15766/mep_2374-8265.11222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/20/2021] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Evidence supports an ultrasound-guided approach in patients with difficult vascular access. Prior research on teaching ultrasound-guided intravenous access has included only small groups of first- and second-year medical students. METHODS We enrolled fourth-year medical students in our teaching module. The module featured a 6-minute prelearning narrated lecture and 5-minute orientation, followed by ultrasound-guided IV placement on homemade gel models. Facilitators were emergency medicine (EM) residents with a prespecified level of procedural ultrasound skills according to EM milestones. Students completed pre- and postmodule surveys. Facilitators completed the Directly Observed Procedural Skills Evaluation. Primary outcomes included global rating, proficiency on six procedural skills, and perceived learning. RESULTS Our module was completed by 150 fourth-year medical students (94% of the class); 84% cannulated the vein in one attempt. We used a global rating scale to describe the students' cannulation abilities; 59% were trusted to perform this procedure with direct supervision and coaching, 29% with indirect supervision, and 8% without supervision. There was no association between a student's order of attempting IV access within the group and global rating (p = .41). Students reported increased understanding of indications, antecubital anatomy, sonographic anatomy, and procedural comfort (12%, 29%, 38%, and 65% improvement pre- vs. postmodule, respectively; p < .001). DISCUSSION Our module enabled more than one-third of fourth-year medical students to achieve an indirect supervision or better level of proficiency in ultrasound-guided IV access, with significant improvements in perceived knowledge. This module may be useful for other educators facilitating the transition to residency.
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Affiliation(s)
- Robert James Adrian
- Fourth-Year Resident, Department of Emergency Medicine, Rutgers New Jersey Medical School
| | - April Choi
- Fourth-Year Resident, Department of Emergency Medicine, Rutgers New Jersey Medical School
| | - Sangeeta Lamba
- Professor, Department of Emergency Medicine, Rutgers New Jersey Medical School
| | - Ilya Ostrovsky
- Assistant Professor, Department of Emergency Medicine, Rutgers New Jersey Medical School
| | - Christine Ramdin
- Research Associate, Department of Emergency Medicine, Rutgers New Jersey Medical School
| | - Christin Traba
- Assistant Professor, Department of Pediatrics, Rutgers New Jersey Medical School
| | - Sophia Chen
- Assistant Professor, Department of Emergency Medicine, Rutgers New Jersey Medical School
| | - Alexander Sudyn
- Fourth-Year Medical Student, Rutgers New Jersey Medical School
| | - Stephen Alerhand
- Assistant Professor, Department of Emergency Medicine, Rutgers New Jersey Medical School
- Corresponding author:
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Delacruz N, Malia L, Dessie A. Point-of-Care Ultrasound for the Evaluation and Management of Febrile Infants. Pediatr Emerg Care 2021; 37:e886-e892. [PMID: 33273426 DOI: 10.1097/pec.0000000000002300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Febrile infants frequently present to the emergency department (ED) and account for a vulnerable population at significant risk for serious bacterial infection. Appropriate evaluation and management are key to favorable outcomes but can present challenges for providers, especially in EDs where ill children are infrequently seen and pediatric-trained staff may not be available. Point-of-care ultrasound (POCUS) is integrated into the care of adults in the ED but is less commonly used for infants. OBJECTIVE OF REVIEW We present a review of the current literature and proposed approach to using POCUS for bladder catheterization, lumbar puncture (LP), and vascular access in the resuscitation and evaluation of febrile infants. DISCUSSION Point-of-care ultrasound can be a useful adjunct in the evaluation of febrile infants by facilitating higher success rates of infant bladder catheterization, LP, and intraosseous and intravenous (IV) line placement. Ultrasound has been shown to be a reliable method of evaluating bladder volumes before the catheterization of infants, reducing the number of attempts needed to obtain an adequate urine sample for testing and culture. Point-of-care ultrasound has also been shown to improve the yield of LPs in infants. Ultrasound is a rapid and accurate way of identifying the appropriate location and depth of needle insertion. Point-of-care ultrasound has also been shown to facilitate obtaining IV access in infants as well as confirming the proper placement of intraosseous lines. CONCLUSIONS A growing body of evidence suggests that POCUS is a useful adjunct in the initial evaluation and resuscitation of febrile infants. It is the position of both the American Academy or Pediatrics, American College of Emergency Physicians, and the authors of this article that emergency physicians should be familiar with the indications and applications of POCUS in children. This technology should be used as an adjunct to improve success rates when performing bladder catheterization, LP, and obtaining intravenous/intraosseous access for infants.
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Affiliation(s)
- Nicolas Delacruz
- From the Department of Pediatrics, New York Presbyterian-Morgan Stanley Children's Hospital
| | - Laurie Malia
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian-Morgan Stanley Children's Hospital, New York, NY
| | - Almaz Dessie
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian-Morgan Stanley Children's Hospital, New York, NY
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Abo AM, Alade KH, Rempell RG, Kessler D, Fischer JW, Lewiss RE, Raio CC, Marin JR. Credentialing Pediatric Emergency Medicine Faculty in Point-of-Care Ultrasound: Expert Guidelines. Pediatr Emerg Care 2021; 37:e1687-e1694. [PMID: 30624416 DOI: 10.1097/pec.0000000000001677] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT As point-of-care ultrasound (POCUS) becomes standard practice in pediatric emergency medicine (PEM), it is important to have benchmarks in place for credentialing PEM faculty in POCUS. Faculty must be systematically trained and assessed for competency in order to be credentialed in POCUS and granted privileges by an individual institution. Recommendations on credentialing PEM faculty are needed to ensure appropriate, consistent, and responsible use of this diagnostic and procedural tool. It is our intention that these guidelines will serve as a framework for credentialing faculty in PEM POCUS.
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Affiliation(s)
- Alyssa M Abo
- From the Departments of Pediatrics and Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Kiyetta H Alade
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Rachel G Rempell
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - David Kessler
- Departments of Pediatrics and Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Jason W Fischer
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Resa E Lewiss
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Christopher C Raio
- Department of Emergency Medicine, Good Samaritan Hospital Medical Center, West Islip, NY
| | - Jennifer R Marin
- Departments of Pediatrics and Emergency Medicine, University of Pittsburgh, Pittsburgh, PA
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Narayanasamy S, Ding L, Yang F, Gunter J, Samuels P, Mecoli M. Feasibility study of cumulative sum (CUSUM) analysis as a competency assessment tool for ultrasound-guided venous access procedures. Can J Anaesth 2021; 69:256-264. [PMID: 34755274 DOI: 10.1007/s12630-021-02149-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Typically, physician training programs use a self-reported case-log competency assessment that does not measure procedure success or objectively assess competency. Cumulative sum (CUSUM) analysis could provide objective assessments of competency and progress over the training period. Our study objective was to determine the feasibility of CUSUM analysis to assess competency of ultrasound-guided peripheral intravenous (USG-PIV) line placement in pediatric anesthesiology fellows. METHODS We applied a CUSUM analysis to assess competency in USG-PIV placement in three consecutive pediatric anesthesia fellowship classes. After a didactic and hands-on training session, fellows placed a USG-PIV line and self-reported the outcomes via a web-based application. Fellows were deemed competent if the CUSUM curve crossed two consecutive boundary lines from above. RESULTS Twenty-nine fellows reported 1,388 USG-PIV attempts, with 74% success. Most fellows (26/29; 90%) achieved competency by the end of the fellowship. Two fellows identified in the mid-year CUSUM as not progressing towards competency achieved competency after targeted interventions. Fellows achieving competency (11/29 vs 25/29; odds ratio, 15; 95% confidence interval [CI], 1.98 to 113.56; P = 0.01) and attempts needed to achieve competency (19 vs 11; mean difference, 8.5; 95% CI, 3.3 to 13.7; P = 0.002) were significantly lower in younger patients and significantly higher in older patients. CONCLUSION Our study showed that CUSUM can be used to assess competence in USG-PIV procedures performed by pediatric anesthesia fellows and to identify learners not progressing toward competency in procedural skills. Ultrasound-guided venous access required more attempts to achieve competency in younger patients.
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Affiliation(s)
- Suryakumar Narayanasamy
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue MLC 2001, Cincinnati, OH, 45229, USA.
| | - Lili Ding
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Fang Yang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Department of Mathematical Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Joel Gunter
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue MLC 2001, Cincinnati, OH, 45229, USA
| | - Paul Samuels
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue MLC 2001, Cincinnati, OH, 45229, USA
| | - Marc Mecoli
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue MLC 2001, Cincinnati, OH, 45229, USA
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Briggs CV, Smith-Steinert R, Bakis M. Continuing Education for the Certified Registered Nurse Anesthetist: Ultrasound-Guided Peripheral Intravenous Access. J Contin Educ Nurs 2021; 52:489-492. [PMID: 34609244 DOI: 10.3928/00220124-20210913-09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Vascular access is critical in the perioperative arena and is a requirement for most surgical procedures. The goals of this project were to increase knowledge among certified registered nurse anesthetists (CRNAs) by providing a focused didactic and simulation course on ultrasound-guided peripheral intravenous access and to assess the confidence and comfort levels of performing ultrasound-guided peripheral intravenous access before and after the course. A combined didactic and simulation ultrasound-based education course was developed to train CRNAs in ultrasound-guided peripheral intravenous access. The training module consisted of a didactic presentation followed by a simulation with fabricated and human models. All participants showed competency during the training course by identifying upper extremity and lower extremity sonographic vascular anatomy on a human model and performing ultrasound-guided intravenous access on fabricated models. Mean correct pretest response was 1.57 (95% confidence interval) compared with 3.53 (95% confidence interval) on the posttest. The findings show improvement in performance of ultrasound-guided peripheral intravenous access by CRNAs after a focused ultrasound education session. [J Contin Educ Nurs. 2021;52(10):489-492.].
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Peters ME, Boriosi JP, Sklansky DJ, Hollman GA, Eickhoff JC, Christenson DK, Shadman KA. Reducing Delays in a Pediatric Procedural Unit With Ultrasound-Guided Intravenous Line Insertion. Hosp Pediatr 2021; 11:1222-1228. [PMID: 34607884 DOI: 10.1542/hpeds.2021-005870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Delay in vascular access is a leading cause of procedure delay in our pediatric procedure and infusion center. Use of ultrasound decreases time to peripheral intravenous catheter (PIV) insertion; however, ultrasound availability in our center was limited to an external venous access team (VAT). The objective of this project was to reduce PIV-related delays by 25%. METHODS Stakeholders convened and theorized that creating a unit-based nurse team specializing in ultrasound-guided peripheral intravenous catheter (USgPIV) insertion would facilitate faster access and a reduction in delayed procedures. An initial plan-do-study-act cycle was performed, training 2 nurses in USgPIV placement. Subsequent cycles were focused on increasing availability of USgPIV-trained nurses. The outcome measure was the rate of procedures delayed by PIV placement, analyzed on a statistical process control U-chart. The process measure was the percentage of USgPIV placements requiring consultations to the VAT, analyzed on a statistical process control P-chart. The balancing measure was the success rate per method of insertion. Comparisons of success rates were conducted by using a χ2 test and Fisher's exact test. RESULTS The mean rate of procedures delayed because of vascular access fell by special cause variation from 10.8% to 6.4%. The mean VAT consultation rate fell from 86.4% to 32.0%. The VAT had higher rates of overall success (100% vs 87%; P = .01) and first-attempt success (93% vs 77%; P = .03) compared with unit nurse USgPIV placement. CONCLUSIONS Unit-based USgPIV placement in a pediatric procedural center was successfully implemented, with a significant decline in procedures delayed by PIV access.
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Infrared vein imaging for insertion of peripheral intravenous catheter for patients requiring isolation for SARS-CoV-2 infection: a nonrandomized clinical trial. J Emerg Nurs 2021; 48:159-166. [PMID: 35115182 PMCID: PMC8506227 DOI: 10.1016/j.jen.2021.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/24/2021] [Accepted: 10/03/2021] [Indexed: 11/25/2022]
Abstract
Introduction Establishing intravenous access is essential but may be difficult to achieve for patients requiring isolation for severe acute respiratory syndrome coronavirus 2 infection. This study aimed to investigate the effectiveness of an infrared vein visualizer on peripheral intravenous catheter therapy in patients with coronavirus disease 2019. Methods A nonrandomized clinical trial was performed. In total, 122 patients with coronavirus disease 2019 who required peripheral intravenous cannulation were divided into 2 groups with 60 in the control group and 62 in the intervention group. A conventional venipuncture method was applied to the control group, whereas an infrared vein imaging device was applied in the intervention group. The first attempt success rate, total procedure time, and patients’ satisfaction score were compared between the 2 groups using chi-square, t test, and z test (also known as Mann-Whitney U test) statistics. Results The first attempt success rate in the intervention group was significantly higher than that of control group (91.94% vs 76.67%, ꭓ2 = 5.41, P = .02). The procedure time was shorter in the intervention group (mean [SD], 211.44 [68.58] seconds vs 388.27 [88.97] seconds, t = 12.27, P < .001). Patients from the intervention group experienced a higher degree of satisfaction (7.5 vs 6, z = −3.31, P < .001). Discussion Peripheral intravenous catheter insertion assisted by an infrared vein visualizer could improve the first attempt success rate of venipuncture, shorten the procedure time, and increase patients’ satisfaction.
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de la Vieja-Soriano M, Blanco-Daza M, Macip-Belmonte S, Dominguez-Muñoz M, López-Sánchez E, Pérez-Pérez E. Difficult intravenous access in a paediatric intensive care unit. ENFERMERIA INTENSIVA 2021; 33:S1130-2399(21)00057-2. [PMID: 34246557 DOI: 10.1016/j.enfi.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Multiple attempts during peripheral cannulation can have major consequences for patients, relatives, and healthcare professionals, therefore we set out to determine the extent of this problem in a paediatric intensive care unit (PICU). OBJECTIVES The main aim was to describe peripheral venous catheter (PVC) and peripherally inserted central catheter (PICC) cannulation in children in the PICU. Secondary objectives were to determine the success rate of the first cannulation attempt, to quantify patients with difficult venous access (DVA), and to explore the association between DVA and sociodemographic, technique and nursing-related characteristics. METHOD A cross-sectional descriptive study. Consecutive sampling was used to recruit patients aged 0-18 years admitted to the PICU who required peripheral venous cannulation. An ad hoc questionnaire was used for this purpose, including the presence of DVA as an independent variable. RESULTS A total of 163 venous cannulations were reported. A total of 55.8% (91) were performed in patients under 1 year of age. Of these, 38.7% (63) were successful on the first attempt and 36.8% (60) had DVA. When there was DVA, 85% (51) of patients had complications, median time to cannulation by short CVP was 30minutes [15-53] and 2 or more nurses were required on 80% (48) of occasions. CONCLUSIONS We found a low success rate at first attempt and a high proportion of DVA. More nurses and time were employed during cannulation and complications increased if the patient had DVA. A statistically significant association was found between DVA and age, weight, poor perfusion, veins that were neither visible nor palpable, DIVA score≥4, history of difficult intravenous access, complications, number of nurses and time spent.
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Affiliation(s)
- M de la Vieja-Soriano
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, España.
| | - M Blanco-Daza
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, España
| | - S Macip-Belmonte
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, España
| | - M Dominguez-Muñoz
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, España
| | - E López-Sánchez
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, España
| | - E Pérez-Pérez
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, España
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Huang HP, Zhao WJ, Wen F, Li XY. Application of ultrasound-guided radial artery cannulation in paediatric patients: A systematic review and meta-analysis. Aust Crit Care 2021; 34:388-394. [PMID: 33097369 DOI: 10.1016/j.aucc.2020.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/11/2020] [Accepted: 09/01/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Numerous studies have demonstrated the benefits and safety of ultrasound guidance in comparison with conventional palpation for radial artery cannulation in adult patients. However, the current evidence for paediatric patients is not fully understood. OBJECTIVE The objective of this study was to compare the efficiency and safety of ultrasound guidance with those of traditional palpation for radial artery cannulation in paediatric patients and provide convincing evidence for clinical practice. METHODS PubMed, Cochrane Library, ClinicalTrials.gov (Min et al-2019, NCT02795468, Anantasit et al-2017, NCT02668471), China National Knowledge Infrastructure, and Wanfang Data were systematically searched from their inception until December 31, 2019, to identify relevant randomised controlled trials. Data were extracted from the included studies independently by two investigators. The primary outcome of interest was the first-attempt success rate. Review Manager Version 5.3 and trial sequential analysis (beta = 0.9) were applied to analyse the collected data. RESULTS A total of eight randomised controlled trials involving 680 paediatric patients were included in this study. The pooled findings showed that ultrasound-guided radial artery cannulation, in comparison with traditional palpation, can significantly improve the first-attempt success rate (relative risk [RR] = 1.65, 95% confidence interval [CI] = 1.36-2.01, P < 0.00001). Trial sequential analysis indicated that this available evidence was conclusive. Moreover, ultrasound guidance was associated with an increased total success rate (RR = 1.38, 95% CI = 1.15-1.66, P = 0.0004), a decreased mean procedural time (standardised mean difference = -0.89, 95% CI = -1.52 to -0.25, P = 0.006), and incidence of haematoma (RR = 0.19, 95% CI = 0.10-0.35, P < 0.00001). CONCLUSION Ultrasound-guided radial arterial cannulation in paediatric patients is associated with improved first-attempt success rates, total success rates, and mean procedural time and decreased incidence of haematoma. The current evidence suggests that ultrasound guidance should be the standard of care for radial artery cannulation in clinical practice.
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Affiliation(s)
- Hua-Ping Huang
- Operation Room of Mianyang Central Hospital, Sichuan, China.
| | - Wen-Jun Zhao
- Operation Room of Mianyang Central Hospital, Sichuan, China
| | - Fang Wen
- Operation Room of Mianyang Central Hospital, Sichuan, China
| | - Xiao-Yu Li
- Pediatric Department of Mianyang Central Hospital, Sichuan, China
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Russell C, Mullaney K, Campbell T, Sabado J, Haut C. Outcomes of a Pediatric Ultrasound-Guided Short Peripheral Catheter Training Program and Hands-On Poultry Simulation Course. JOURNAL OF INFUSION NURSING 2021; 44:204-215. [PMID: 34197350 DOI: 10.1097/nan.0000000000000427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ultrasound guidance is an effective technique for obtaining short peripheral catheter (SPC) access but requires training and practice for proficiency. The aim of this quality improvement initiative was to develop and assess a formal training program to increase the confidence and competency of intravenous (IV) therapy nurses in the placement of ultrasound-guided SPCs. IV therapy nurses completed a didactic and hands-on training course where they practiced ultrasound-guided SPC placement techniques on a poultry phantom during simulation, followed by performing ultrasound-guided SPC insertion on patients proctored by an interventional radiology physician. Data collection included preintervention and postintervention confidence self-assessment, frequency tracker, Difficult Intravenous Access (DIVA) scale scores, and total number of ultrasound-guided SPCs placed by the nurses. Ultrasound-guided SPC placement increased significantly after the training program. The IV therapy nurses placed 29 ultrasound-guided SPCs in 2017, 391 ultrasound-guided SPCs in 2018, and 711 ultrasound-guided SPCs in 2019. Mean DIVA scores rose from 4.54 in May 2018 to 5.17 in July 2018, indicating success in placing SPCs in more difficult patients. Implementation of an ultrasound-guided SPC placement program using poultry phantom simulation is a recommended nursing resource for increasing competency in ultrasound-guided SPC placement in pediatric patients.
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Affiliation(s)
- Christina Russell
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware (Mss Russell, Mullaney, and Campbell, and Drs Sabado and Haut); Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Mss Mullaney and Campbell); Thomas Jefferson University, Philadelphia, Pennsylvania (Dr Sabado)
- Christina Russell, BSN, RN, HTCP, HNB-BC, is currently the healing touch coordinator for the Department of Integrative Medicine at Nemours/Alfred I. duPont Hospital for Children. She served as nurse manager for the intravenous (IV) therapy team during this quality improvement (QI) project. Ms Russell is also a registered yoga teacher
- Kathleen Mullaney, MSN, APRN, ACCNS-P, CRNI®, served as a clinical nurse educator for the IV Therapy Team at Nemours/Alfred I. duPont Hospital for Children during this QI project. She is currently a clinical nurse specialist at Children's Hospital of Philadelphia
- Tracy Campbell, MSN, APRN, PCNS-BC, CCRN , served as a clinical nurse specialist for the IV Therapy Team at Nemours/Alfred I. duPont Hospital for Children during this QI project. She is currently a nursing practice specialist at Children's Hospital of Philadelphia
- Jeremiah Sabado, MD, is a pediatric interventional radiologist at Nemours/Alfred I. duPont Hospital for Children. He is also a clinical instructor of pediatrics at Sidney Kimmel Medical College at Thomas Jefferson University
- Catherine Haut, DNP, CPNP-AC, PC, is the Director of Nursing Research and Evidence-Based Practice at Nemours/Alfred I. duPont Hospital for Children
| | - Kathleen Mullaney
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware (Mss Russell, Mullaney, and Campbell, and Drs Sabado and Haut); Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Mss Mullaney and Campbell); Thomas Jefferson University, Philadelphia, Pennsylvania (Dr Sabado)
- Christina Russell, BSN, RN, HTCP, HNB-BC, is currently the healing touch coordinator for the Department of Integrative Medicine at Nemours/Alfred I. duPont Hospital for Children. She served as nurse manager for the intravenous (IV) therapy team during this quality improvement (QI) project. Ms Russell is also a registered yoga teacher
- Kathleen Mullaney, MSN, APRN, ACCNS-P, CRNI®, served as a clinical nurse educator for the IV Therapy Team at Nemours/Alfred I. duPont Hospital for Children during this QI project. She is currently a clinical nurse specialist at Children's Hospital of Philadelphia
- Tracy Campbell, MSN, APRN, PCNS-BC, CCRN , served as a clinical nurse specialist for the IV Therapy Team at Nemours/Alfred I. duPont Hospital for Children during this QI project. She is currently a nursing practice specialist at Children's Hospital of Philadelphia
- Jeremiah Sabado, MD, is a pediatric interventional radiologist at Nemours/Alfred I. duPont Hospital for Children. He is also a clinical instructor of pediatrics at Sidney Kimmel Medical College at Thomas Jefferson University
- Catherine Haut, DNP, CPNP-AC, PC, is the Director of Nursing Research and Evidence-Based Practice at Nemours/Alfred I. duPont Hospital for Children
| | - Tracy Campbell
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware (Mss Russell, Mullaney, and Campbell, and Drs Sabado and Haut); Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Mss Mullaney and Campbell); Thomas Jefferson University, Philadelphia, Pennsylvania (Dr Sabado)
- Christina Russell, BSN, RN, HTCP, HNB-BC, is currently the healing touch coordinator for the Department of Integrative Medicine at Nemours/Alfred I. duPont Hospital for Children. She served as nurse manager for the intravenous (IV) therapy team during this quality improvement (QI) project. Ms Russell is also a registered yoga teacher
- Kathleen Mullaney, MSN, APRN, ACCNS-P, CRNI®, served as a clinical nurse educator for the IV Therapy Team at Nemours/Alfred I. duPont Hospital for Children during this QI project. She is currently a clinical nurse specialist at Children's Hospital of Philadelphia
- Tracy Campbell, MSN, APRN, PCNS-BC, CCRN , served as a clinical nurse specialist for the IV Therapy Team at Nemours/Alfred I. duPont Hospital for Children during this QI project. She is currently a nursing practice specialist at Children's Hospital of Philadelphia
- Jeremiah Sabado, MD, is a pediatric interventional radiologist at Nemours/Alfred I. duPont Hospital for Children. He is also a clinical instructor of pediatrics at Sidney Kimmel Medical College at Thomas Jefferson University
- Catherine Haut, DNP, CPNP-AC, PC, is the Director of Nursing Research and Evidence-Based Practice at Nemours/Alfred I. duPont Hospital for Children
| | - Jeremiah Sabado
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware (Mss Russell, Mullaney, and Campbell, and Drs Sabado and Haut); Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Mss Mullaney and Campbell); Thomas Jefferson University, Philadelphia, Pennsylvania (Dr Sabado)
- Christina Russell, BSN, RN, HTCP, HNB-BC, is currently the healing touch coordinator for the Department of Integrative Medicine at Nemours/Alfred I. duPont Hospital for Children. She served as nurse manager for the intravenous (IV) therapy team during this quality improvement (QI) project. Ms Russell is also a registered yoga teacher
- Kathleen Mullaney, MSN, APRN, ACCNS-P, CRNI®, served as a clinical nurse educator for the IV Therapy Team at Nemours/Alfred I. duPont Hospital for Children during this QI project. She is currently a clinical nurse specialist at Children's Hospital of Philadelphia
- Tracy Campbell, MSN, APRN, PCNS-BC, CCRN , served as a clinical nurse specialist for the IV Therapy Team at Nemours/Alfred I. duPont Hospital for Children during this QI project. She is currently a nursing practice specialist at Children's Hospital of Philadelphia
- Jeremiah Sabado, MD, is a pediatric interventional radiologist at Nemours/Alfred I. duPont Hospital for Children. He is also a clinical instructor of pediatrics at Sidney Kimmel Medical College at Thomas Jefferson University
- Catherine Haut, DNP, CPNP-AC, PC, is the Director of Nursing Research and Evidence-Based Practice at Nemours/Alfred I. duPont Hospital for Children
| | - Catherine Haut
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware (Mss Russell, Mullaney, and Campbell, and Drs Sabado and Haut); Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Mss Mullaney and Campbell); Thomas Jefferson University, Philadelphia, Pennsylvania (Dr Sabado)
- Christina Russell, BSN, RN, HTCP, HNB-BC, is currently the healing touch coordinator for the Department of Integrative Medicine at Nemours/Alfred I. duPont Hospital for Children. She served as nurse manager for the intravenous (IV) therapy team during this quality improvement (QI) project. Ms Russell is also a registered yoga teacher
- Kathleen Mullaney, MSN, APRN, ACCNS-P, CRNI®, served as a clinical nurse educator for the IV Therapy Team at Nemours/Alfred I. duPont Hospital for Children during this QI project. She is currently a clinical nurse specialist at Children's Hospital of Philadelphia
- Tracy Campbell, MSN, APRN, PCNS-BC, CCRN , served as a clinical nurse specialist for the IV Therapy Team at Nemours/Alfred I. duPont Hospital for Children during this QI project. She is currently a nursing practice specialist at Children's Hospital of Philadelphia
- Jeremiah Sabado, MD, is a pediatric interventional radiologist at Nemours/Alfred I. duPont Hospital for Children. He is also a clinical instructor of pediatrics at Sidney Kimmel Medical College at Thomas Jefferson University
- Catherine Haut, DNP, CPNP-AC, PC, is the Director of Nursing Research and Evidence-Based Practice at Nemours/Alfred I. duPont Hospital for Children
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Jørgensen R, Laursen CB, Konge L, Pietersen PI. Education in the placement of ultrasound-guided peripheral venous catheters: a systematic review. Scand J Trauma Resusc Emerg Med 2021; 29:83. [PMID: 34176508 PMCID: PMC8237454 DOI: 10.1186/s13049-021-00897-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 05/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Placing a peripheral vein catheter can be challenging due to several factors, but using ultrasound as guidance increases the success rate. The purpose of this review is to investigate the knowledge already existing within the field of education in ultrasound-guided peripheral vein catheter placement and explore the efficacy and clinical impact of different types of education. METHODS In accordance with PRISMA-guidelines, a systematic search was performed using three databases (PubMed, EMBASE, CINAHL). Two reviewers screened titles and abstracts, subsequently full-text of the relevant articles. The risk of bias was assessed using the Cochrane Collaboration risk of bias assessment tool and the New Ottawa scale. RESULTS Of 3409 identified publications, 64 were included. The studies were different in target learners, study design, assessment tools, and outcome measures, which made direct comparison difficult. The studies addressed a possible effect of mastery learning and found e-learning and didactic classroom teaching to be equally effective. CONCLUSION Current studies suggest a potential benefit of ultrasound guided USG-PVC training on success rate, procedure time, cannulation attempts, and reducing the need for subsequent CVC or PICC in adult patients. An assessment tool with proven validity of evidence to ensure competence exists and education strategies like mastery learning, e-learning, and the usage of color Doppler show promising results, but an evidence-based USG-PVC-placement training program using these strategies combined is still warranted.
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Affiliation(s)
- Rasmus Jørgensen
- Department of Respiratory Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark. .,Regional Center for Technical Simulation, Region of Southern Denmark, 5000, Odense, Denmark.
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark.,Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Lars Konge
- Regional Center for Technical Simulation, Region of Southern Denmark, 5000, Odense, Denmark.,Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Pia Iben Pietersen
- Department of Respiratory Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark.,Regional Center for Technical Simulation, Region of Southern Denmark, 5000, Odense, Denmark
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Shaahinfar A, Ghazi-Askar ZM. Procedural Applications of Point-of-Care Ultrasound in Pediatric Emergency Medicine. Emerg Med Clin North Am 2021; 39:529-554. [PMID: 34215401 DOI: 10.1016/j.emc.2021.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Point-of-care ultrasound can improve efficacy and safety of pediatric procedures performed in the emergency department. This article reviews ultrasound guidance for the following pediatric emergency medicine procedures: soft tissue (abscess incision and drainage, foreign body identification and removal, and peritonsillar abscess drainage), musculoskeletal and neurologic (hip arthrocentesis, peripheral nerve blocks, and lumbar puncture), vascular access (peripheral intravenous access and central line placement), and critical care (endotracheal tube placement, pericardiocentesis, thoracentesis, and paracentesis). By incorporating ultrasound, emergency physicians caring for pediatric patients have the potential to enhance their procedural scope, confidence, safety, and success.
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Affiliation(s)
- Ashkon Shaahinfar
- Division of Emergency Medicine, UCSF Benioff Children's Hospital Oakland, Trailer 3, 747 52nd Street, Oakland, CA 94609, USA; Department of Emergency Medicine, UCSF School of Medicine, 550 16th Street, MH5552, San Francisco, CA, USA.
| | - Zahra M Ghazi-Askar
- Department of Emergency Medicine, Stanford School of Medicine, 300 Pasteur Drive, Room M121, Alway Building MC 5768, Stanford, CA 94305, USA
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Training the Trainers in Ultrasound-guided Access to Improve Peripheral Intravenous Catheter Placement among Children Presenting for Anesthesia. Pediatr Qual Saf 2021; 6:e406. [PMID: 33977194 PMCID: PMC8104256 DOI: 10.1097/pq9.0000000000000406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/19/2020] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is available in the text. Factors predicting difficult peripheral intravenous (PIV) catheter placement in children are known. Ultrasound guidance can decrease the number of attempts required for difficult PIV placement. However, the uptake of this technique among attending anesthesiologists at our institution remained low. This study aimed to reduce the incidence of PIV placement requiring greater than 3 attempts and reduce time to PIV placement by providing training in ultrasound guidance.
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Haroon-Mowahed Y, Cheen Ng S, Barnett S, West S. Ultrasound in paediatric anaesthesia - A comprehensive review. ULTRASOUND (LEEDS, ENGLAND) 2021; 29:112-122. [PMID: 33995558 PMCID: PMC8083139 DOI: 10.1177/1742271x20939260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 06/09/2020] [Indexed: 11/16/2022]
Abstract
The use of ultrasound is becoming more widespread in anaesthesia. In this review, we discuss the use of ultrasound in various aspects of paediatric anaesthesia and how it can be used to assist diagnostic and therapeutic interventions and the evidence available. We explore the use of ultrasound as an adjunct for regional anaesthesia, vascular access, airway management, bedside cardiac, pulmonary and abdominal imaging and intracranial pressure monitoring.
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Affiliation(s)
- Yumna Haroon-Mowahed
- Department of Anaesthetics, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London UK
| | - Su Cheen Ng
- Department of Anaesthetics, University College Hospital, London, UK
| | - Sarah Barnett
- Department of Anaesthetics, University College Hospital, London, UK
| | - Simeon West
- Department of Anaesthetics, University College Hospital, London, UK
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Bian Y, Huang Y, Bai J, Zheng J, Huang Y. A randomized controlled trial of ultrasound-assisted technique versus conventional puncture method for saphenous venous cannulations in children with congenital heart disease. BMC Anesthesiol 2021; 21:131. [PMID: 33906601 PMCID: PMC8077689 DOI: 10.1186/s12871-021-01349-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/16/2021] [Indexed: 11/16/2022] Open
Abstract
Background The study investigated the success rate of the great saphenous venous catheter placement performed by ultrasound-assisted technique compared with the conventional puncture method in infants and toddlers with congenital heart disease and aimed to assess the efficiency and feasibility of this method within the context of pediatric peripheral venous access. Methods We selected infants and toddlers who underwent congenital cardiac surgery in our medical center from June 1, 2020, to September 7, 2020, by convenience sampling. Children were stratified by the presence of the manifesting cardiac types (cyanotic or acyanotic heart disease). They were assigned to the conventional puncture method group or the ultrasound-assisted group through randomly blocked randomization. The primary outcome was the success rate of the first attempt. The second outcomes included the time to cannulation at the first attempt, the redirections of the first attempt, overall puncture time, and overall redirections of efforts. Besides, a binary logistic regression model was implemented to identify the possible variables related to the success rate of the first attempt. Results A total of 144 children in our medical center were recruited in the study. The success rate of the first attempt in the ultrasound-assisted group was higher than that of the conventional puncture method group in the stratification of cyanotic children (66.7% vs. 33.3%, P = 0.035). Among children of acyanotic kind, the difference in the success rate of the first attempt between the two groups was not significant (57.6% vs. 42.4%, P = 0.194). Overall puncture time (45.5 s vs. 94 s, P = 0.00) and the time to cannulation at the first attempt (41.0 s vs. 60 s, P = 0.00) in the ultrasound-assisted group was less than the conventional puncture method group. The ultrasound-assisted group also required fewer redirections of the first attempt (three attempts vs. seven attempts, P = 0.002) and fewer total redirections of efforts (two attempts vs. three attempts, P = 0.027) than the conventional puncture method group. The result of binary Logistic regression showed that the success rate of the first attempt was related to age (OR:1.141; 95% CI = 1.010–1.290, P = 0.034), the redirections of the first attempt (OR:0.698; 95% CI = 0.528–0.923, P = 0.012) and the saphenous venous width (OR:1.181; 95% CI = 1.023–1.364, P = 0.023). Conclusions The ultrasound-assisted technique improves the saphenous venous cannulation sufficiently in children with difficult peripheral veins. The younger age is associated with a higher likelihood of peripheral venous difficulty. The ultrasound-assisted methods can effectively screen peripheral veins, e.g., selecting thicker diameter peripheral veins, making puncture less uncomfortable, and improving success rates. This method can be used as one of the effective and practical ways of peripheral venipuncture in children, especially in difficult situations. It should be widely applied as one of the alternative ultrasound techniques in the operating room. Trial registration ChiCTR.org.cn (ChiCTR-2,000,033,368). Prospectively registered May 29, 2020.
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Affiliation(s)
- Yong Bian
- Department of Anesthesiology, Shanghai Children's Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong, Shanghai, 200127, China
| | - Yanhui Huang
- Department of Anesthesiology, Shanghai Children's Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong, Shanghai, 200127, China
| | - Jie Bai
- Department of Anesthesiology, Shanghai Children's Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong, Shanghai, 200127, China
| | - Jijian Zheng
- Department of Anesthesiology and Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yue Huang
- Department of Anesthesiology, Shanghai Children's Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong, Shanghai, 200127, China.
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Saxena A, Ng EYK, Canchi T, Lim JL, Beruvar AS. A method to produce high contrast vein visualization in active dynamic thermography (ADT). Comput Biol Med 2021; 132:104309. [PMID: 33735761 DOI: 10.1016/j.compbiomed.2021.104309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/14/2021] [Accepted: 03/01/2021] [Indexed: 02/07/2023]
Abstract
In this study, a method that will aid in the visualization of vein topology on a target area on the body of a human subject is demonstrated. An external cooling means is configured to cool the left forearm of fourteen study participants, effecting an active thermal change or recovery in the target area upon removal of cooling. An infrared (IR) thermal camera was used to capture a series of transient thermal images. These images were then processed to extract Dynamic synthetic images (SI) throughout the active thermal change or recovery process. Dynamic SI was calculated using a quantitative parameter called tissue activity ratio (TAR), which is defined by the rate of rewarming to the rate of cooling at each pixel of interest. A fixed step size of rewarming temperature (0.5 °C) was used to progressively extract multiple synthetic images throughout the whole recovery process. Compared to a Static SI extraction method, where only a single SI results from the whole active dynamic thermography (ADT) sequence, this study demonstrates a live feed of high contrast vein visualizations by using the Dynamic SI method. Furthermore, the dependency of Dynamic SI contrast on the temperature of the external cooling stimulation was investigated. Three cooling stimulation temperatures (5 °C, 8 °C, and 11 °C) were tested, where no statistically significant difference in the resulting SI contrast was found. Lastly, a discussion is put forth on assisting venipuncture or cannulation-based clinical applications, through the incorporation of the proposed method with a projection system.
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Affiliation(s)
- Ashish Saxena
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Ave, 639798, Singapore
| | - Eddie Yin Kwee Ng
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Ave, 639798, Singapore.
| | - Tejas Canchi
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Ave, 639798, Singapore; School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Jia Ler Lim
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Ave, 639798, Singapore
| | - Ayush Singh Beruvar
- Department of Mechanical Engineering, National Institute of Technology, Silchar, 788010, India
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Gümüş M, Başbakkal Z. Efficacy of Veinlite PEDI in Pediatric Peripheral Intravenous Access: A Randomized Controlled Trial. Pediatr Emerg Care 2021; 37:145-149. [PMID: 29794951 DOI: 10.1097/pec.0000000000001515] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
METHODS A total of 112 pediatric patients were enrolled in the study. Children who presented to the emergency department aged 1 to 10 years old were randomly assigned to the Veinlite PEDI (Veinlite) group or standard of care (SoC) group. The primary outcome measure was first attempt success. Secondary outcome measures were number of intravenous (IV) attempts and time to peripheral intravenous catheter (PIC) placement. RESULTS A total of 110 patients completed the study: 58 boys and 52 girls. The first attempt success rate was significantly higher in the Veinlite group compared with the SoC group (92.9% vs 72.2%, P < 0.004). In addition, the Veinlite group had a fewer number of attempts compared with the SoC group (1.07 ± 0.54 vs 1.31 ± 0.25, P = 0.04). The Veinlite group resulted in a shorter total time of attempts per patient compared with the SoC group (49.98 ± 18.4 vs 59.68 ± 22.5 P = 0.01). CONCLUSIONS The use of new technology in the Veinlite PEDI (TransLite, Sugar Land, Tex), to assist with peripheral IV access in children, improves the first time success rate for IV access. Improved visualization of veins also reduced the number of attempts and the time required for PIC placement. These results suggest that the new technology of the Veinlite results in better PIC access than Veinlite transilluminaton device with white light.
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Affiliation(s)
- Merve Gümüş
- From the Department of Pediatric Nursing, Faculty of Nursing, Ege University, İzmir, Turkey
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45
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Anderson AP, Taroc AM, Wang X, Beardsley E, Solari P, Klein EJ. Ultrasound guided peripheral IV placement: An observational study of the learning curve in pediatric patients. J Vasc Access 2021; 23:250-256. [PMID: 33467970 DOI: 10.1177/1129729820987958] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Ultrasound guided peripheral intravenous catheter placement (USGPIV) has demonstrated benefits in children including higher success rates and fewer attempts compared to the traditional technique. Little is known about the experience needed to establish competence with USGPIV in children. In adult patients, nurses with four USGPIV attempts had a subsequent 70% probability of success after training. The objective of this study is to measure the competency of nurses with USGPIV in children after training. METHODS Pediatric nurses completed 2 h of training on USGPIV, after which they used ultrasound at their discretion for children with difficult access. Data was collected prospectively via study forms and retrospectively from medical records. Mixed effects logistic regression models were used to estimate the probability of successful USGPIV placement. RESULTS Thirty-five nurses underwent training from the pediatric emergency department and intravenous access team. The overall USGPIV success rate was 70%. Participants with less nursing experience made more USGPIV attempts than those with more experience, but had similar success rates. Forty percent of participants performed ten or more attempts during the study period. Mixed effects logistic regression estimated that it took nine USGPIV attempts after training for learners to achieve a 70% probability of success for the subsequent attempt. CONCLUSION After training, 40% of participants adopted USGPIV into their practice. When developing training programs for USGPIV for children with difficult access, trainers can anticipate the experience needed to acquire this skill and the fact that not everyone trained will use this skill in their daily practice.
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Affiliation(s)
- Andrea P Anderson
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Ann-Marie Taroc
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Xing Wang
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | | | - Patrick Solari
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Eileen J Klein
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
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Li HA, Zhang M, Yu K, Qi X, Tong J. A Displacement Estimated Method for Real Time Tissue Ultrasound Elastography. MOBILE NETWORKS AND APPLICATIONS 2021; 26:2014-2023. [PMCID: PMC7957449 DOI: 10.1007/s11036-021-01735-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 06/14/2023]
Abstract
As an important means of medical imaging, elastic imaging is an indispensable part of mobile telemedicine. Ultrasound elastography has become a research hotspot because it can accurately measure soft tissue lesions. Displacement estimation is the most important step in ultrasound elastography. At present, the phase zero search method is an accurate and fast displacement estimation method. However, when the displacement exceeds 1/4 wavelength, it is invalid. The accuracy of block matching method is not high, but it is suitable for large displacement, so it can overcome this shortcoming. It is worth noting that the quality-guided block matching method has good robustness under complex mutation conditions. It can provide prior knowledge to increase the robustness of the phase-zero search under large displacement conditions. So we propose a novel displacement estimation method for real time tissue ultrasound elastography, which combines the quality-guided block matching method and the phase-zero search method. The experimental results show that this method is more accurate, faster and robust than other displacement estimation methods.
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Affiliation(s)
- Hong-an Li
- College of Computer Science and Technology, Xi’an University of Science and Technology, Xi’an, China
| | - Min Zhang
- College of Computer Science and Technology, Xi’an University of Science and Technology, Xi’an, China
| | - Keping Yu
- Global Information and Telecommunication Institute, Waseda University, Tokyo, 169-8050 Japan
| | - Xin Qi
- Global Information and Telecommunication Institute, Waseda University, Tokyo, 169-8050 Japan
| | - Jianfeng Tong
- School of Information Science and Technology, Northwest University, Xi’an, 710127 China
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Ye X, Li M. Comparison of Ultrasound Guided and Conventional Techniques for Peripheral Venous Catheter Insertion in Pediatric Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Pediatr 2021; 9:797705. [PMID: 35198520 PMCID: PMC8859100 DOI: 10.3389/fped.2021.797705] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/23/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Ultrasound guided cannulation for peripheral venous insertion is a well-established methodology. However, there has never been a systematic review completed to synthesize evidence within the pediatric population. The current systematic review and meta-analysis was completed to compare the efficacy and safety profile of ultrasound guided peripheral cannulation against the conventional palpation technique within pediatric patients. METHODS A comprehensive search was conducted within the digital databases including Medline, EMBASE, ScienceDirect, Google Scholar and Cochrane library from inception until August 2021. A meta-analysis was then completed with random-effects model and reported pooled risk ratio (RR) or standardized mean difference (SMD) with 95% confidence interval (CI). RESULTS In total, 9 studies were analyzed, which included 1,312 participants, and the majority of studies (5 out 9 studies) were considered high quality. Amongst efficacy outcomes, first attempt success rate had a pooled RR of 1.53 (95% CI: 1.14-2.04), overall success rate had a pooled RR of 1.13 (95% CI: 1.01-1.26), number of attempts before successful cannulation had a pooled SMD of -1.93 [95%CI: -3.44 to -0.42], time taken for successful cannulation had a pooled SMD of -0.46 [95%CI: -1.20 to 0.28], needle redirections before successful cannulation had a pooled SMD of -1.26 [95%CI: -2.47 to -0.06]. Amongst safety outcomes, venous extravasation had a pooled RR of 1.59 (95% CI: 0.99-2.54) and phlebitis had an RR of 0.31 (95% CI: 0.07-1.50). CONCLUSION Within pediatric patients, ultrasound guided peripheral venous cannulation is more efficacious when compared to the conventional palpation technique.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021275305, identifier: CRD42021275305.
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Affiliation(s)
- Xiulan Ye
- Department of Pediatric, The Hospital Subordinate to Qin Hai University, Xi Ning, China
| | - Ming Li
- Department of Pediatric, The Hospital Subordinate to Qin Hai University, Xi Ning, China
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Shokoohi H, Loesche MA, Duggan NM, Liteplo AS, Huang C, Al Saud AA, McEvoy D, Liu SW, Dutta S. Difficult intravenous access as an independent predictor of delayed care and prolonged length of stay in the emergency department. J Am Coll Emerg Physicians Open 2020; 1:1660-1668. [PMID: 33392574 PMCID: PMC7771794 DOI: 10.1002/emp2.12222] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Difficult intravenous access (DIVA) is common in the emergency department (ED). We investigated the extent to which DIVA is associated with care delay outcomes including time to first laboratory draw, therapies, imaging, and ED disposition. METHODS An observational retrospective cohort analysis of patients with DIVA treated between 2018 and 2020 at 2 urban academic EDs was performed. DIVA was defined as patients requiring ultrasound-guided intravenous access placed by physicians or advanced practice providers (APPs) as opposed to landmark-based intravenous placement by nurses. ED throughput variables and disposition time were compared. We correlated DIVA with time to administration of intravenous pain medications, fluids, imaging contrast, laboratory results, and ED disposition. RESULTS A total of 108,256 subjects with 161,122 total encounters were included. DIVA occurred in 4961 (3.1%) of ED visits. Patients with DIVA were more likely to be female (3.5% vs 2.6% for males, odds ratio [OR] 1.34, 95% confidence interval [CI]: 1.27-1.42), self-identify as black (OR 1.78, 95% CI: 1.66-1.91), and have higher acuity of illness (P < 0.001). Among pediatric patients, DIVA occurred most often in the first year of life at a rate of 3.25%. In adults, DIVA occurred in 2 age peaks; at 35 years (4.02%), and at 63 years (3.44%). In all workflow metrics, the presence of DIVA was associated with significant delays in median time to completion: 50 minutes for pain medication administration, 36 minutes for intravenous fluid administration, 29 minutes for laboratory results, 57 minutes for intravenous contrast administration, and 87 minutes for discharge orders. CONCLUSION DIVA was associated with increased time to therapies, diagnostic studies, imaging completion, and ED disposition. A more expeditious approach to achieving intravenous access in patients with predicted DIVA could improve ED throughput and patient care overall.
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Affiliation(s)
- Hamid Shokoohi
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Michael A. Loesche
- Department of Emergency MedicineMassachusetts General HospitalHarvard Affiliated Emergency Medicine Residency ProgramBostonMassachusettsUSA
| | - Nicole M. Duggan
- Department of Emergency MedicineMassachusetts General HospitalHarvard Affiliated Emergency Medicine Residency ProgramBostonMassachusettsUSA
| | - Andrew S. Liteplo
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Calvin Huang
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Ahad A. Al Saud
- Division of Emergency UltrasoundDepartment of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Dustin McEvoy
- Clinical Data AnalystPartners HealthCareSomervilleMassachusettsUSA
| | - Shan W. Liu
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Sayon Dutta
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
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Davis EM, Feinsmith S, Amick AE, Sell J, McDonald V, Trinquero P, Moore A, Gappmaier V, Colton K, Cunningham A, Ford W, Feinglass J, Barsuk JH. Difficult intravenous access in the emergency department: Performance and impact of ultrasound-guided IV insertion performed by nurses. Am J Emerg Med 2020; 46:539-544. [PMID: 33191044 DOI: 10.1016/j.ajem.2020.11.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Difficult intravenous access (DIVA) is a common problem in Emergency Departments (EDs), yet the prevalence and clinical impact of this condition is poorly understood. Ultrasound-guided peripheral intravenous catheter (USGPIV) insertion is a successful modality for obtaining intravenous (IV) access in patients with DIVA. OBJECTIVES We aimed to describe the prevalence of DIVA, explore how DIVA affects delivery of care, and determine if nurse insertion of USGPIV improves care delays among patients with DIVA. METHODS We retrospectively queried the electronic medical record for all ED patients who had a peripheral IV (PIV) inserted at a tertiary academic medical center from 2015 to 2017. We categorized patients as having DIVA if they required ≥3 PIV attempts or an USGPIV. We compared metrics for care delivery including time-to-IV-access, time-to-laboratory-results, time-to-IV-analgesia, and ED length of stay (LOS) between patients with and without DIVA. We also compared these metrics in patients with DIVA with a physician-inserted USGPIV versus those with a nurse-inserted USGPIV. RESULTS A total of 147,260 patients were evaluated during the study period. Of these, 13,192 (8.9%) met criteria for DIVA. Patients with DIVA encountered statistically significant delays in time-to-IV-access, time-to-laboratory-results, time-to-IV-analgesia, and ED LOS compared to patients without DIVA (all p < 0.001). Patients with nurse-inserted USGPIVs also had statistically significant improvements in time-to-IV-access, time-to-laboratory-results, time-to-IV-analgesia, and ED LOS compared to patients with physician-inserted USGPIVs (all p < 0.001). CONCLUSION DIVA affects many ED patients and leads to delays in PIV access-related care. Nurse insertion of USGPIVs improves care in patients with DIVA.
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Affiliation(s)
- Evan M Davis
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Sarah Feinsmith
- Department of Emergency Medicine, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Ashley E Amick
- Department of Emergency Medicine, Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA.
| | - Jordan Sell
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Valerie McDonald
- Department of Emergency Medicine, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Paul Trinquero
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Arthur Moore
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Victor Gappmaier
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katharine Colton
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrew Cunningham
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - William Ford
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joseph Feinglass
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Jeffrey H Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Ballard HA, Tsao M, Robles A, Phillips M, Hajduk J, Feinglass J, Barsuk JH. Use of a simulation-based mastery learning curriculum to improve ultrasound-guided vascular access skills of pediatric anesthesiologists. Paediatr Anaesth 2020; 30:1204-1210. [PMID: 32594590 DOI: 10.1111/pan.13953] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/14/2020] [Accepted: 06/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pediatric vascular access is inherently challenging due to the small caliber of children's vessels. Ultrasound-guided intravenous catheter insertion has been shown to increase success rates and decrease time to cannulation in patients with difficult intravenous access. Although proficiency in ultrasound-guided intravenous catheter insertion is a critical skill in pediatric anesthesia, there are no published competency-based training curricula. AIMS The objective of this study was to evaluate the performance of pediatric anesthesiologists who participated in a novel ultrasound-guided intravenous catheter insertion simulation-based mastery learning curriculum. METHODS Pediatric anesthesia attendings, fellows, and rotating residents participated in the ultrasound-guided intravenous catheter insertion simulation-based mastery learning curriculum from August 2019 to February 2020. The 2-hour curriculum consisted of participants first undergoing a simulated skills pretest followed by watching a video on ultrasound-guided intravenous catheter insertion and deliberate practice on a simulator. Subsequently, all participants took a post-test and were required to meet or exceed a minimum passing standard. Those who were unable to meet the minimum passing standard participated in further practice until they could be retested and met this standard. We compared pre to post-test ultrasound-guided intravenous catheter insertion skills and self-confidence before and after participation in the curriculum. RESULTS Twenty-six pediatric anesthesia attendings, 12 fellows, and 38 residents participated in the curriculum. At pretest, 16/76 (21%) participants were able to meet or exceed the minimum passing standard. The median score on the pretest was 21/25 skills checklist items correct and improved to 24/25 at post-test (95% CI 3.0-4.0, P < .01). Self-confidence significantly improved after the course from an average of 3.2 before the course to a postcourse score of 3.9 (95% CI 0.5-0.9, P < .01; 1 = Not all confident, 5 = Very confident). CONCLUSIONS Simulation-based mastery learning significantly improved anesthesiologists' ultrasound-guided intravenous catheter insertion performance in a simulated setting.
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Affiliation(s)
- Heather A Ballard
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA.,Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Michelle Tsao
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA.,Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Alison Robles
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA.,Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Mitch Phillips
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA.,Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - John Hajduk
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA.,Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Joseph Feinglass
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.,Department of Medicine, Northwestern Memorial Hospital, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey H Barsuk
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.,Department of Medicine, Northwestern Memorial Hospital, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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