Peripheral Venous Cannulation
Conditions
Brief summary
This is a randomized controlled prospective study. The purpose of this study is to compare a recently described technique of ultrasound (US) guided, dynamic needle tip positioning (DNTP), to the traditional technique of vein visualization and palpation for peripheral venous cannulation in intubated, sedated, and mechanically ventilated pediatric intensive care unit (PICU) patients. First attempt success rate, overall success rate within 3 attempts or 10 minutes (whichever comes first), number of attempts to success, time to success and cannula sizes will be compared between the 2 techniques. The study will include intubated, sedated and mechanically ventilated children, aged 0-18 years, hospitalized in the PICU who require peripheral intravenous (PIV) access for their management.
Interventions
PROCEDUREUS guided dynamic needle tip positioning peripheral intravenous cannulation
Catheterizations will be performed by one of three pediatric intensivists with vast experience in both traditional and US guided DNTP techniques for peripheral intravenous access. The operator will be allowed to independently choose which peripheral vein to cannulate. If necessary, patients will be given supplemental dose of sedation and analgesia in addition to the already given continuous infusions for invasive mechanical ventilation. Before puncture, the limb will be taped and maintained in an optimal position. A tourniquet will be placed proximal to the planned cannulation site. The site of puncture will be disinfected with Chlorhexidine gluconate 0.5% w/v, Alcohol 70% v/v. The choice of catheter will be left to the discretion of the operator. Available PIV cannulas include : 14 GA, 2X45 mm; 17 GA, 1.4X45 mm; 18 GA 1.2X45 mm; 20 GA 1X32mm BD Venflon™ and 24 GA, 0.7X19 mm; 26 GA 0.6X19 mm BD Neoflon™ (Becton Dickinson Infusion Therapy AB, Helsingborg, Sweden).
PROCEDURETraditional peripheral intravenous cannulation
For traditional insertion technique insertion attempt will be blind or tactile.
Sponsors
Rabin Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
No minimum to 18 Years
Healthy volunteers
No
Inclusion criteria
1. Invasively ventilated 2. Younger than 18 years 3. Peripheral venous access required 4. Difficult intravenous access (DIVA) score of 4 or greater (on a scale of 0-10 with higher scores implying more difficult access)
Exclusion criteria
1. Refusal to consent 2. Research staff not available
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Success of peripheral IV cannulation on first attempt | 10 minutes | Assessment of peripheral IV cannulation success on first attempt (Yes vs No) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall peripheral IV cannulation success rate | 10 minutes | The overall success rate of peripheral intravenous cannulation within 3 attempts. |
| Time to successful peripheral IV cannulation | up to 10 minutes | Defined as the time from first skin puncture to successful cannulation (minutes). |
| Number of attempts to success | up to 10 minutes | Number of puncture attempts (1,2 or 3) needed for achieving a a successful cannulation |
| Inserted cannula diameter | up to 10 minutes | Cannula diameter (in GA) successfully inserted |
Other
| Measure | Time frame | Description |
|---|---|---|
| Patient age | 1 day (At the time of peripheral IV cannulation) | Age in years |
| Reason for admission | 1 day (At the time of peripheral IV cannulation) | Medical vs Surgical |
| Patient sex | 1 day (At the time of peripheral IV cannulation) | Female vs Male |
| Patient body mass index (BMI) | 1 day (At the time of peripheral IV cannulation) | BMI (in kg/m\^2) for age percentile |
| Patient inotropic and vasoactive support | 1 day (At the time of peripheral IV cannulation) | Vasoactive-Inotropic Score (VIS score) |
| Admission-cannulation time | 1 day (At the time of peripheral IV cannulation) | Time from hospital admission to first attempt of cannulation |
Contacts
Primary ContactAvichai Weissbach, MD
Outcome results
None listed