Using ultrasound to guide insertion of peripheral venous cannula in infants and children improves the overall success rate by nearly 80%, suggests a study recently published in the journal Pediatrics.¹

A systematic review and meta-analysis of randomized trials was conducted to determine the effectiveness of ultrasound-guided peripheral venous cannulation on the first attempt in infants and children. For this various databases including Medline, Embase, CENTRAL, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov were searched. Trials that compared ultrasound-guided PIVC insertion against the landmark-based approach in the pediatric age group were selected for analysis. Nine studies involving 1350 patients, from a total of 1033 studies screened, were included in the analysis.

Five of 8 studies showed a statistically significant improvement in successful insertion of peripheral intravenous catheter on the first attempt itself, which was the primary aim of the analysis. Cannulation was successful in 78% in the first attempt among the ultrasound group vs 66% in the control group with pooled odds ratio (OR) of 2.61. 

The overall success rate, which was the secondary objective of the study, was 93% in the ultrasound group compared to 78% in the control group. The chances of successful insertion improved 3-folds when ultrasound was used as a guide compared with the landmark technique in studies where 3 or more attempts had been made with pooled OR of 3.57. Improvement in single-operator technique and short-axis technique was noted in subgroup analyses.

Peripheral IV cannulation is a commonly performed technique for IV access but it is challenging to perform in infants and children with high first-attempt failure rate. Children have small veins, they are also less visible to the eye and insertion is often blind; hence a landmark-based approach is not always fruitful. Moreover, children tend to be less cooperative to the procedure. Multiple attempts are painful to the child and also increase parental anxiety. Also, there is a learning curve for the practitioner.

This meta-analysis has provided evidence of improved success, in first attempt and overall success rate, with ultrasound-guided insertion compared to the standard landmark-based technique in children including in children with difficult intravenous access.

Reference

1. Mitchell EO, et al. Ultrasound for pediatric peripheral intravenous catheter insertion: a systematic review. Pediatrics. 2022 May 1;149(5):e2021055523. doi: 10.1542/peds.2021-055523.