Should We Use Ultrasound-Guided IV in Kids?

Written by Megan Hilbert

Spoon Feed
Ultrasound guided peripheral intravenous cannulation (PIVC) has been shown to be effective in some pediatric populations.

Why does this matter?
Difficult intravenous access (DIVA – authors’ acronym, not my own) is made all the more difficult in the pediatric population where there are additional confounding variables to control for – not least of which is the small caliber of the target vessels. The use of ultrasound to gain IV access has been shown to statistically increase odds of successful cannulation.

Little people, little veins
This is a systematic review and meta-analysis of RCTs regarding the use of ultrasound in pediatric PIVC. Nine studies were included with the primary objective of determining the effect of ultrasound on first-attempt insertion success rates. Ultrasound showed increased success on first attempt (78%) in five of the studies as compared to control (66%).  Secondary objectives included overall success rates – in which four of the studies reported increased overall success rates with ultrasound (93%) compared to control (78%). There was a large amount of heterogeneity among the studies, limiting further conclusions, and specifically no comment could be made on the time to successful placement.

Interestingly, the majority of these studies were completed in the OR setting with sedated patients on vasodilatory medications, greatly limiting the generalizability of these conclusions. The data did, however, demonstrate a tendency toward improvement with a single operator and short-axis technique under dynamic guidance – something we ED docs are familiar with and do with regularity. While more research needs to be done to control for ED-specific confounders (ie: lack of sedated patients), it is probably a good idea to turn to ultrasound sooner in your anticipated “DIVAs.”

Source
Ultrasound for Pediatric Peripheral Intravenous Catheter Insertion: A Systematic Review. Pediatrics. 2022 May 1;149(5):e2021055523. doi: 10.1542/peds.2021-055523.

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