Abstract
Introduction
Intravenous access is required for resuscitation of injured patients but may be delayed
in children because of challenges associated with peripheral intravenous (PIV) catheter
placement. Early identification of factors predisposing patients to difficult PIV
placement can assist in deciding strategies for timely intravenous access.
Methods
We conducted a retrospective, video-based review of injured children and adolescents
treated between April 2018 and May 2019. Patient demographic, physiological, injury,
and resuscitation characteristics were obtained from the patient record, including
age, race, weight, injury type, Injury Severity Score, initial systolic blood pressure,
initial Glasgow Coma Score, intubation status, activation level, and presence of prearrival
notification. Video review was used to determine the time to PIV placement, the number
of attempts required, the purpose for additional access, and the reason for abandonment
of PIV placement. Multivariable regressions were used to determine factors associated
with successful placement.
Results
During the study period, 154 consented patients underwent attempts at PIV placement
in the trauma bay. Placement was successful in 139 (90.3%) patients. Older patients
(OR [odds ratio]: 0.9, 95% confidence interval [CI]: 0.9, 0.9) and patients who required
the highest level activation response (OR: 0.0, 95% CI: 0.0, 0.3) were less likely
to have an attempt at PIV placement abandoned. Children with nonblunt injuries (OR:
11.6, 95% CI: 1.3, 119.2) and pre-existing access (OR: 39.6, 95% CI: 7.0, 350.6) were
more likely to have an attempt at PIV placement abandoned. Among patients with successful
PIV placement, the time required for establishing PIV access was faster as age increased
(−0.5 s, 95% CI: −1.1, −0.0).
Conclusions
Younger age was associated with abandonment of PIV attempts and, when successful,
increased time to placement. Strategies to improve successful PIV placement and alternate
routes of access should be considered early to prevent treatment delays in younger
children.
Keywords
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Article info
Publication history
Published online: November 21, 2022
Accepted:
October 18,
2022
Received in revised form:
September 16,
2022
Received:
June 28,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
