Topical anaesthesia and intravenous cannulation success in paediatric patients: a randomized double-blind trial. [Assertiveness and peripheral intravenous catheters dwell time with ultrasonography-guided insertion in children and adolescents]. Amethocaine versus EMLA for successful intravenous cannulation in a children’s emergency department: a randomised controlled study Ultrasound-assisted peripheral vascular access in a paediatric ED. Efficacy of a Near-Infrared Light Device in Pediatric Intravenous Cannulation: A Randomized Controlled Trial Near-Infrared Imaging in Intravenous Cannulation in Children: A Cluster Randomized Clinical Trial Ultrasound guidance allows faster peripheral IV cannulation in children under 3 years of age with difficult venous access: a prospective randomized study. Ultrasound or near-infrared vascular imaging to guide peripheral intravenous catheterization in children: a pragmatic randomized controlled trial Evaluating NIR vascular imaging to support intravenous cannulation in awake children difficult to cannulate; a randomized clinical trial. The Effectiveness of a Near-Infrared Vascular Imaging Device to Support Intravenous Cannulation in Children with Dark Skin Color: A Cluster Randomized Clinical Trial Warm lidocaine/tetracaine patch versus placebo before pediatric intravenous cannulation: a randomized controlled trial. Standard-length catheters vs long catheters in ultrasound-guided peripheral vein cannulation. Randomized Controlled Trial of Ultrasound-Guided Peripheral Intravenous Catheter Placement Versus Traditional Techniques in Difficult-Access Pediatric Patients IV access difficulty: incidence and delays in an urban emergency department. A randomized controlled trial comparing the AccuVein AV300 device to standard insertion technique for intravenous cannulation of anesthetized children.
BACKGROUND It is not known whether the choice of topical anaesthetic influences the likelihood of successful i.v . cannulation in the paediatric population . The null hypothesis of this study was that no difference exists in the initial success rate of cannulation between two commonly used topical anaesthetics . METHODS A r and omized double-blind trial conducted on patients between the age of 12 months and 12 yr presenting to a tertiary hospital emergency department . Patients requiring cannulation were r and omized to either 4 % amethocaine gel ( AnGEL ) or 5 % lidocaine and prilocaine in a 1:1 emulsion ( EMLA ) . The primary endpoint was success of initial attempt at i.v . cannulation . RESULTS One hundred and seventy-seven patients were analysed of 203 enrolled . The success rate of AnGEL ( 73/97 , 75 % ) and EMLA ( 59/80 , 74 % ) did not significantly differ ( chi2(1 ) 0.05 , P=0.82 ) . CONCLUSIONS No difference exists in the cannulation success rates between the two anaesthetics . The choice of topical anaesthetic in paediatric cannulation should be based on other factors such as cost , time to anaesthesia , efficacy of the agent , and adverse effect profile R and omized controlled trial which aim ed to verify whether the use of vascular ultrasound ( VUS ) increases assertiveness in the use of  peripheral venous catheter in children , and the catheter dwell time , when compared to traditional puncture . Data were collected after approval of theethical merit . Children and adolescents undergoing VUS-guided peripheral intravenous ( GVUS ) or puncture guided by clinical assessment of the venous conditions(CG ) were included in the study . Significance level was set at p < or = 0.05 . The sample was composed of 382 punctures  , 188 ( 49.2 % ) in VUS G and 194 ( 50.8 % ) in CG , performed in 335 children . Assertiveness was found in 73 ( 71.6 % ) GVUS catheters and in 84(71.8 % ) of the CG ( p=0.970 ) , and catheter dwell time presented a median of less than one day in both groups ( p=0.121 ) , showing nostatistically significant difference . VUS did not significantly influence the results of the dependent variables investigated . Clinical Trials.govNCT00930254 Background : Topical anaesthetics reduce the pain of venous cannulation . The emergency department at the Starship Children ’s Hospital in Auckl and uses EMLA ( an eutectic mixture of 25 mg/g lidocaine and 25 mg/g prilocaine ) for topical anaesthesia . Amethocaine has recently been shown to be a more effective topical anaesthetic . It is suggested that , because amethocaine does not vasoconstrict veins , it may increase the success of cannulation . Aim : The primary aim was to determine if amethocaine improves the success of cannulation compared with EMLA . The secondary aim was to determine if amethocaine is a more effective topical anaesthetic in a children ’s emergency department . Methods : A parallel , r and omised , double-blind controlled study was performed in children aged 3 months to 15 years who were offered topical anaesthesia for venous cannulation .  Caregivers gave verbal consent at triage , followed by written consent . Children were r and omised into amethocaine or EMLA groups . Those who went on to have an intravenous cannula were analysed on an intention-to-treat basis . The primary outcome was a successful first attempt at cannulation . A convenience cohort was also observed for distress using a visual analogue scale and the Faces , Legs , Activity , Cry and Consolability Score . Results : From November 2006 to June 2007 , 2837 children were enrolled and 809 were known to have had intravenous cannulation . 679 complete data and consent forms were returned . There was no significant difference between the first attempt success rates ( 75.8 % amethocaine vs 73.9 % EMLA ) or between pain scores for the 65 observed cannulations . Conclusion : Amethocaine is not more successful than EMLA for first attempt intravenous cannulation in a children ’s emergency department . Trial registration number : Australian New Zeal and Clinical Trials Register ACTRN12606000409572 OBJECTIVES To assess the implementation and utility of US for assisting peripheral venous access in a paediatric ED . METHODS A prospect i ve , observational study of a convenience sample comparing the l and mark and US-guided technique for peripheral vascular access in children from July 2006 to February 2007 . Clinicians involved under went 3 months of training in US physics and with practical models . Clinicians estimated the degree of difficulty of insertion ( using a Likert scale ) before each line placement . Data including time of procedure and success or failure were collected , using a st and ardized clinical record form , by an observing research er . RESULTS A total of 84 patients were enrolled . There were 61 line placement episodes in the l and mark group ( with 253 attempts ) , and 38 in the US group ( with 90 attempts ) . US recorded slightly higher success per attempt overall ( 42 % vs 38 % , P=0.08 ) , and performed better in the patients with difficult access ( success 35 % vs 18 % , P=0.003 ) .  US attempts took longer than l and mark attempts ( 2 min 15 s vs 4 min , P<0.001 ) . CONCLUSION The US guidance may improve the success rate of peripheral vascular access in children rated to have difficult or very difficult vascular access Objectives : To determine whether the use of a near-infrared light venipuncture aid ( VeinViewer ; Luminetx Corporation , Memphis , Tenn ) would improve the rate of successful first-attempt placement of intravenous ( IV ) catheters in a high-volume pediatric emergency department ( ED ) . Methods : Patients younger than 20 years with st and ard clinical indications for IV access were r and omized to have IV placement by ED nurses ( in 3 groups stratified by 5-year blocks of nursing experience ) using traditional methods ( st and ard group ) or with the aid of the near-infrared light source ( device group ) . If a vein could not be cannulated after 3 attempts , patients crossed over from one study arm to the other , and study nurses attempted placement with the alternative technique . The primary end point was first-attempt success rate for IV catheter placement . After completion of patient enrollment , a question naire was completed by study nurses as a qualitative assessment of the device . Results : A total of 123 patients ( median age , 3 years ) were included in the study : 62 in the st and ard group and 61 in the device group . There was no significant difference in first-attempt success rate between the st and ard ( 79.0 % , 95 % confidence interval [ CI ] , 66.8%-88.3 % ) and device ( 72.1 % , 95 % CI , 59.2%-82.9 % ) groups . Of the 19 study nurses , 14 completed the question naire of whom 70 % expressed neutral or unfavorable assessment s of the device in nondehydrated patients without chronic underlying medical conditions and 90 % found the device a helpful tool for patients in whom IV access was difficult . Conclusions : First-attempt success rate for IV placement was nonsignificantly higher without than with the assistance of a near-infrared light device in a high-volume pediatric ED . Nurses placing IVs did report several benefits to use of the device with specific patient groups , and future research should be conducted to demonstrate the role of the device in these patients OBJECTIVE : Intravenous cannulation is a widespread medical procedure that can be difficult in children . Visualization of veins with near-infrared ( NIR ) light might support intravenous cannulation . Therefore , we investigated the effectiveness of an NIR vascular imaging system ( VascuLuminator ) in facilitating intravenous cannulation in children in the operating room . METHODS : This was a pragmatic , cluster r and omized clinical trial in all consecutive children ( 0–18 years ) scheduled for elective surgery and in need of intravenous cannulation at a tertiary pediatric referral hospital . Daily operating rooms ( 770 patients ) were r and omized for allocation of the VascuLuminator or control group . The primary outcome was success at first attempt ; the secondary outcome was time to successful cannulation . RESULTS : Success at first attempt was 70 % ( 171/246 ) with and 71 % ( 175/245 ) without the use of the VascuLuminator ( P = .69 ) . Time to successful cannulation was 162 ( ±14 ) seconds and 143 ( ±15 ) seconds respectively ( P = .26 ) . In 83.3 % , the vein of first choice was visible with the VascuLuminator . CONCLUSIONS : Although it was possible to visualize veins with NIR in most patients , the VascuLuminator did not improve success rate or time to obtain intravenous cannulation . There are 3 possible explanations for this result : first , it could be that localization of the vein is not the main problem , and therefore visualization is not a solution ; second , the type of system used in this study could be less than optimal ; and , third , the choice of the patient population in this study could be inappropriate OBJECTIVES Ultrasound-guided peripheral venous access ( USG-PIVA ) presents many advantages over the reference ' blind ' technique in both adults and children in emergency situations . AIM To compare USG-PIVA with the blind technique in children <3 years undergoing general anesthesia . METHODS After obtaining the approval of the ethics committee and informed consent from the parents , we included all children <3 years scheduled to undergo general anesthesia [ surgery , magnetic resonance imaging ( MRI ) ] , who presented difficult venous access . The children were r and omized into two groups : the US group ( USG-PIVA ) and the B group ( blind ) . The primary endpoint was time to cannulation ( from tourniquet placement to successful IV cannulation ) , compared between USG-PIVA group and B group by intention-to-treat analysis . Secondary outcomes were success rate at the first puncture , number of punctures , and diameter of the catheters . Cannulations requiring > 15 min were considered as failures . In case of failure in group B , USG-PIVA was attempted for a further 15 min . RESULTS Twenty children were included in each group . Groups were comparable for sex , age , and BMI . Significant differences were observed in median time to cannulation ( 63.5 s vs 420.5 s , USG-PIVA vs B respectively , P < 0.001 ) ; median number of punctures ( 1 vs 2.5 , USG-PIVA vs B , P = 0.004 ) ; and success rate at first cannulation ( 85 % vs 35 % , USG-PIVA vs B , P = 0.0012 ) . In contrast , overall success rate did not differ significantly between groups ( 90 % vs 85 % , USG-PIVA vs B , P = 0.63 ) . CONCLUSIONS Ultrasound-guided peripheral venous access leads to faster peripheral IV access and should therefore be recommended in children presenting with difficult venous access Background : Peripheral intravenous catheterization in children is challenging , and success rates vary greatly . We conducted a pragmatic r and omized controlled trial to determine whether the use of ultrasound or near-infrared vascular imaging to guide catheterization would be more effective than the st and ard approach in achieving successful catheter placement on the first attempt . Methods : We enrolled a convenience sample of 418 children in a pediatric emergency department who required peripheral intravenous catheterization between June 2010 to August 2012 . We stratified them by age ( ≤ 3 yr and > 3 yr ) and r and omly assigned them to undergo the procedure with the st and ard approach , or with the help of either ultrasound or near-infrared vascular imaging . The primary outcome was the proportion of patients who had successful placement of a catheter on the first attempt . Results : The rate of successful first attempts did not differ significantly between either of the 2 intervention groups and the st and ard approach group ( differences in proportions −3.9 % , 95 % confidence interval [ CI ] −14.2 % to 6.5 % , for ultrasound imaging ; −8.7 % , 95 % CI −19.4 % to 1.9 % , for near-infrared imaging ) . Among children 3 years and younger , the difference in success rates relative to st and ard care was also not significant for ultrasound imaging ( −9.6 % , 95 % CI −29.8 % to 10.6 % ) , but it was significantly worse for near-infrared imaging ( −20.1 % , 95 % CI −40.1 % to −0.2 % ) . Among children older than 3 years , the differences in success rates relative to st and ard care were smaller but not significant ( −2.3 % , 95 % CI −13.6 % to 9.0 % , for ultrasound imaging ; −4.1 % , 95 % CI −15.7 % to 7.5 % , for near-infrared imaging ) . None of the pairwise comparisons were statistically significant in any of the outcomes . Interpretation : Neither technology improved first-attempt success rates of peripheral intravenous catheterization in children , even in the younger group . These findings do not support investment in these technologies for routine peripheral intravenous catheterization in children . Trial registration : Clinical Trials.gov , no. NCT01133652 BACKGROUND Recently , various near-infrared vascular imaging devices aim ed at facilitating peripheral intravenous cannulation ( PIC ) were introduced , all cl aim ing to increase success rate of PIC . We evaluated the clinical utility of a near-infrared vascular imaging device ( VascuLuminator ( ® ) ) in pediatric patients who were referred to the anesthesiologist because of difficult cannulation . METHODS There were 226 consecutive children referred to pediatric anesthesiologists by the treating pediatrician of the in- and outpatient clinic , because of difficulties with intravenous cannulation , were included in this cluster r and omized clinical trial . The presence and use of the near-infrared vascular imaging device for PIC was r and omized in clusters of 1 week . Success at first attempt ( Fisher exact test ) and time to successful cannulation ( Log-rank test ) were assessed to evaluate differences between groups . RESULTS Success at first attempt in the group with the VascuLuminator ( ® ) ( 59 % ) was not significantly different from the control group ( 54 % , P = 0.41 ) , neither was the median time to successful cannulation : 246 s and 300 s , respectively ( P = 0.54 ) . CONCLUSIONS Visualization of blood vessels with near-infrared light and with near-infrared vascular imaging device did not improve success of PIC in pediatric patients who are known difficult to cannulate BACKGROUND : Poor vein visibility can make IV cannulation challenging in children with dark skin color . In the operating room , we studied the effectiveness of a near-infrared vascular imaging device ( VascuLuminator ) to facilitate IV cannulation in children with dark skin color . METHODS : In the operating room of a general hospital in Curacao , all consecutive children ( 0–15 years of age ) requiring IV cannulation were included in a pragmatic cluster r and omized clinical trial . The VascuLuminator was made available to anesthesiologists at the operating complex in r and omized clusters of 1 week . RESULTS : Success at first attempt was 63 % ( 27/43 , 95 % confidence interval [ CI ] , 47%–77 % ) in the VascuLuminator group vs 51 % ( 23 of 45 patients , 95 % CI , 36%–66 % ) in the control group ( P = 0.27 ) . Median time to successful cannulation was 53 seconds ( interquartile range : 34–154 ) in the VascuLuminator group and 68 seconds ( interquartile range : 40–159 ) in the control group ( P = 0.54 ) , and hazard ratio was 1.12 ( 95 % CI , 0.73–1.71 ) . CONCLUSION : The VascuLuminator has limited value in improving success at first attempt of facilitating IV cannulation in children with dark skin color STUDY OBJECTIVE We compare the pain of intravenous ( IV ) cannulation in pediatric emergency department ( ED ) patients after applying a topical lidocaine/tetracaine patch versus placebo . We hypothesized that application of the active patch would reduce the pain of IV cannulation by at least 15 mm . METHODS We conducted a r and omized , double-blind , placebo-controlled trial in a suburban academic ED . Patients aged 3 to 17 years who required nonemergency IV cannulation were eligible for enrollment . At triage , a nurse placed a commercially available topical lidocaine/tetracaine patch or an identical-looking placebo patch over the antecubital or h and vein in patients for whom an IV catheter was anticipated . After IV cannulation by the treating nurse , the pain of cannulation was measured on a vali date d 100-mm visual analogue scale or Wong Baker scale . Outcomes were compared between groups with Mann-Whitney U , Student t , and chi(2 ) tests . A sample of 40 patients had 80 % power to detect a 13-mm difference in pain scores . RESULTS Forty-five patients were r and omized to lidocaine/tetracaine patch ( 22 ) or placebo ( 23 ) , and IV cannulation was attempted in 40 of these patients . Mean age was 10 years ( SD=4.3 ) , 35 % were female patients . The median pain of IV cannulation in the active treatment group ( 18 mm [ interquartile range ( IQR ) 1 to 40 mm ] ) was significantly lower than in the placebo group ( 35 mm [ IQR 20 to 59 mm ] ; P=.04 ) . Adequate pain relief was more common in the active treatment group ( 75 % [ 95 % confidence interval ( CI ) 53 % to 89 % ] versus 35 % [ 95 % CI 18 % to 57 % ] ; difference 40 % [ 95 % CI 6 % to 64 % ] ) . The number of successful IV cannulations after the first attempt was similar in both the lidocaine/tetracaine and the placebo groups ( 90 % [ 95 % CI 70 % to 97 % ] versus 85 % [ 95 % CI 64 % to 95 % ] ; difference 5 % ( 95 % CI -21 % to 30 % ) . CONCLUSION Application of a topical lidocaine/tetracaine patch result ed in a modest reduction in the pain of IV cannulation in pediatric ED patients and did not alter the rate of successful cannulations PURPOSE Ultrasound ( US ) is a useful tool for peripheral vein cannulation in patients with difficult venous access . However , few data about the survival of US-guided peripheral catheters in acute care setting exist . Some studies showed that the survival rate of st and ard-length catheters ( SC ) is poor especially in obese patients . The use of longer than normal catheters could provide a solution to low survival rate . The aim of the present study was to compare US-guided peripheral SCs vs US-guided peripheral long catheters inserted with Seldinger technique ( LC ) in acute hospitalized patients with difficult venous access . METHODS This was a prospect i ve , r and omized controlled trial . A total of 100 consecutively admitted subjects in an urban High Dependency Unit were r and omized to obtain US-guided intravenous access using either SC or LC after 3 failed blind attempts . Primary outcome was catheter failure rate . RESULTS Success rate was 86 % in the SC groups and 84 % in the LC group ( P=.77 ) . Time requested to positioning venous access result ed to be shorter for SC as opposed to LC ( 9.5 vs 16.8 minutes , respectively ; P=.001 ) . Catheter failure was observed in 45 % of patients in the SC group and in 14 % of patients in the LC group ( relative risk , 3.2 ; P<.001 ) . CONCLUSIONS Both SC and LC US-guided cannulations have a high success rate in patients with difficult venous access . Notwithst and ing a higher time to cannulation , LC US-guided procedure is associated with a lower risk of catheter failure compared with SC US-guided procedure Objectives : We hypothesized that the use of ultrasound guidance would improve the success rate of peripheral intravenous catheter placement in pediatric patients with difficult access in a pediatric emergency department ( ED ) . Our secondary hypotheses were that ultrasound guidance would reduce the number of attempts , the number of needle redirections , and the overall time to catheter placement . Methods : This was a prospect i ve r and omized study of pediatric ED patients younger than 10 years old requiring intravenous access , presenting between August 2006 and May 2007 . Inclusion criteria were 2 unsuccessful traditional attempts at peripheral intravenous access or history of difficult access . Exclusion was critical illness or instability . Patients were r and omized to undergo  peripheral intravenous catheter placement  using continued traditional approaches or real-time , dual-operator ultrasound-guided technique . Measured outcomes were success of cannulation , number of attempts , number of needle redirections , and overall time to catheter placement . Results : Fifty patients were enrolled , with 25 patients r and omized to each group . The overall success rates for the ultrasound-guided group were 80 % and for the traditional-attempts group , 64 % , with a difference in proportions of 16 % ( 95 % confidence interval , −9 % to 38 % , P = 0.208 ) . The ultrasound-guided group required less overall time ( 6.3 vs 14.4 minutes , difference of −8.1 minutes [ 95 % confidence interval , −12.5 to −3.6 ] , P = 0.001 ) , fewer attempts ( median , 1 vs 3 ; P = 0.004 ) , and fewer needle redirections ( median , 2 vs 10 ; P < 0.0001 ) than traditional approaches . Conclusions : In a sample of pediatric ED patients with difficult access , ultrasound-guided intravenous cannulation required less overall time , fewer attempts , and fewer needle redirections than traditional approaches BACKGROUND  Intravenous access difficulty ( IVAD ) has long been recognized as a problem for emergency departments ( ED ) , but epidemiologic data are lacking . OBJECTIVE To estimate the incidence of IVAD and its associated delays in an urban ED . METHODS We conducted this prospect i ve cohort study in an urban ED at an academic medical center , enrolling adult patients who were likely to require an IV line . We recorded patients ' history of IVAD and the time from the initial skin puncture to IV line establishment , noting the need for a second provider and the type of provider who was successful . We defined IVAD as follows : none , requiring a single skin puncture ; mild , requiring multiple skin punctures ; moderate , requiring a second non-physician provider ; and severe , requiring a physician . We used descriptive statistics and calculated the relative risk ( and 95 % confidence interval [ CI ] ) for the association between prior IVAD and observed moderate or severe IVAD . RESULTS We enrolled 125 patients , 107 of whom had an IV line placed in the ED . Their median age was 48 ( interquartile range 38 - 60 ) years . The incidence and median delays associated with IVAD categories were as follows : none , 61%/1 min ; mild , 11%/5 min ; moderate , 23%/15 min ; and severe , 5%/120 min . Prior IVAD was associated with a 2.5-fold greater risk of observed IVAD ( 95 % CI 1.3 - 4.7 ) . CONCLUSION In an urban , tertiary care ED , mild and moderate IVAD was common and led to mild delays , but severe IVAD , requiring a physician , caused substantial delays OBJECTIVES AND AIMS To evaluate the efficacy of the AccuVein AV300 device in improving the first-time success rate of intravenous cannulation of anesthetized pediatric patients . BACKGROUND The AccuVein AV300 device was developed to assist venepuncture and intravenous cannulation by enhancing the visibility of superficial veins . It uses infrared light to highlight hemoglobin so that blood vessels are darkly delineated against a red background . METHODS / MATERIAL S Patients were r and omized to cannulation with the AccuVein AV300 device or st and ard insertion by experienced pediatric anesthesiologists . An observer recorded the number of skin punctures and cannulation attempts required , and the time between tourniquet application and successful cannulation or four skin punctures , whichever came first . RESULTS AND CONCLUSIONS There were 146 patients with a median age of 4.6 years ( range , 0.18 - 17.1 years ) , 46.6 % were male , 80.8 % were light skin colored , and 15.7 % were younger than 2 years . The first-attempt success rates were 75 % ( 95 % CI , 63.8 - 84.2 % ) using AV300 and 73 % ( 95 % CI , 61.9 - 81.9 % ) using the st and ard method ( P = 0.85 ) . Patients with dark or medium skin color were 0.38 times less likely to have a successful first attempt than patients with light skin color . The difference between the two treatment groups in number of skin punctures and the time to insertion was not significant . Although the AV300 was easy to use and improved visualization of the veins , we found no evidence that it was superior to the st and ard method of intravenous cannulation in unselected pediatric patients under anesthesia
AIM The aim of this study was to identify interventions associated with peripheral intravenous catheterization first attempt success in pediatric in patients and emergency department patients who require vascular access for therapeutic interventions .
BACKGROUND Unsuccessful peripheral intravenous catheterization puts children at risk for increased pain and treatment delays .
Effective interventions to increase peripheral intravenous catheterization first attempt success are unclear .