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Factors Affecting Peripheral Intravenous Catheter Placement During Pediatric Trauma Resuscitation

Published:November 21, 2022DOI:https://doi.org/10.1016/j.jss.2022.10.048

      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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      References

        • American College of Surgeons Committee on Trauma
        Initial assessment and management.
        in: Advanced Trauma Life Support for Doctors, ATLS Student Course Manual. 10th ed. American College of Surgeons, Chicago2018: 3-21
        • Lininger R.A.
        Pediatric peripheral i.v. insertion success rates.
        Pediatr Nurs. 2003; 29: 351-354
        • American College of Surgeons Committee on Trauma
        Pediatric trauma.
        in: Advanced Trauma Life Support for Doctors, ATLS Student Course Manual. 10th ed. American College of Surgeons, Chicago2018: 187-212
        • Yen K.
        • Riegert A.
        • Gorelick M.H.
        Derivation of the DIVA score: a clinical prediction rule for the identification of children with difficult intravenous access.
        Pediatr Emerg Care. 2008; 24: 143-147
        • Girotto C.
        • Arpone M.
        • Frigo A.C.
        • et al.
        External validation of the DIVA and DIVA3 clinical predictive rules to identify difficult intravenous access in pediatric patients.
        Emerg Med J. 2020; 37: 762-767
        • Rauch D.
        • Dowd D.
        • Eldridge D.
        • et al.
        Peripheral difficult venous access in children.
        Clin Pediatr (Phila). 2009; 48: 895-901
        • Vukovic A.A.
        • Frey M.
        • Byczkowski T.
        • et al.
        Video-based assessment of peripheral intravenous catheter insertion in the resuscitation area of a pediatric emergency department.
        Acad Emerg Med. 2016; 23: 637-644
        • Kuhlenschmidt K.M.
        • Choi E.
        • Moonmoon K.
        • et al.
        Provider perception of time during trauma resuscitation: a prospective quantitative trauma video review analysis.
        J Surg Res. 2022; 274: 207-212
        • Voigt J.
        • Waltzman M.
        • Lottenberg L.
        Intraosseous vascular access for in-hospital emergency use: a systematic clinical review of the literature and analysis.
        Pediatr Emerg Care. 2012; 28: 185-199
        • Alberto E.C.
        • Harvey A.R.
        • Amberson M.J.
        • et al.
        Assessment of non-routine events and significant physiological disturbances during emergency department evaluation after pediatric head trauma.
        Neurotrauma Rep. 2021; 2: 39-47
        • Alberto E.C.
        • Amberson M.J.
        • Cheng M.
        Assessment of nonroutine events during intubation after pediatric trauma.
        J Surg Res. 2021; 259: 276-283
        • O’Neill M.B.
        • Dillane M.
        • Hanipah N.F.
        Validating the difficult intravenous access clinical prediction rule.
        Pediatr Emerg Care. 2012; 28: 1314-1316
        • Bonafide C.
        • Brady P.
        • Keren R.
        • et al.
        Development of heart and respiratory rate percentile curves for hospitalized children.
        Pediatrics. 2013; 131: e1150-e1157
        • de Swiet M.
        • Fayers P.
        • Shinebourne E.
        Systolic blood pressure in a population of infants in the first year of life: the Brompton study.
        Pediatrics. 1980; 65: 1028-1035
        • Rabbia F.
        • Grosso T.
        • Cat Genova G.
        • et al.
        Assessing resting heart rate in adolescents: determinants and correlates.
        J Hum Hypertens. 2002; 16: 327-332
        • Whitney R.
        • Langhan M.
        Vascular access in pediatric patients in the emergency department: types of access, indications, and complications.
        Pediatr Emerg Med Pract. 2017; 14: 1-20
        • Jacobson A.F.
        • Winslow E.H.
        Variables influencing intravenous catheter insertion difficulty and failure: an analysis of 339 intravenous catheter insertions.
        Heart Lung. 2005; 34: 345-359
        • Gerçeker G.Ö.
        • Ayar D.
        • Özdemir E.Z.
        • et al.
        The impact of the difficult vascular access, fear, and anxiety level in children on the success of first-time phlebotomy.
        J Vasc Access. 2018; 19: 620-625
        • Francisco M.D.
        • Chen W.F.
        • Pan C.T.
        • et al.
        Competitive real-time near infrared (NIR) vein finder imaging device to improve peripheral subcutaneous vein selection in venipuncture for clinical laboratory testing.
        Micromachines (Basel). 2021; 12: 373
        • Vyas V.
        • Sharma A.
        • Goyal S.
        • et al.
        Infrared vein visualization devices for ease of intravenous access in children: hope versus hype.
        Anaesthesiol Intensive Ther. 2021; 53: 69-78
        • Chiao F.B.
        • Resta-Flarer F.
        • Lesser J.
        • et al.
        Vein visualization: patient characteristic factors and efficacy of a new infrared vein finder technology.
        Br J Anaesth. 2013; 110: 966-971
        • Bahl A.
        • Pandurangadu A.V.
        • Tucker J.
        • et al.
        A randomized controlled trial assessing the use of ultrasound for nurse-performed IV placement in difficult access ED patients.
        Am J Emerg Med. 2016; 34: 1950-1954
        • Lewis P.
        • Wright C.
        Saving the critically injured trauma patient: a retrospective analysis of 1000 uses of intraosseous access.
        Emerg Med J. 2015; 32: 1463-1467