Ultrasound-guided IV placement improves first-attempt success in children

Physicians who used ultrasound to guide the placement of intravenous (IV) lines in young patients had better first-attempt success rates than those who used traditional methods, according to a study published in the July issue of Annals of Emergency Medicine.

In the study, children with difficult IV access were randomized to receive either line placement from a team trained in ultrasound-guided IV line placement or traditional IV line placement. More than 85% of ultrasound-guided IV placed lines were successful on first-attempt, compared to less than 50% of traditionally placed lines.

"The need to place an intravenous line is a common but challenging requirement for pediatric healthcare providers," said lead investigator Alexandra M. Vinograd, MD. "Our research shows that both the children and their parents are happier with ultrasound-guided line insertion."

If IV access isn’t readily available, patients may face diagnostic and treatment delays, the authors noted, and, in some cases, it can lead to further pain and anxiety for both those being treated and their families.

Vinograd, an emergency medicine physician at the Children's Hospital of Philadelphia (CHOP), and colleagues prospectively enrolled 167 patients in their study. They were divided into two groups: those aged zero to three and three and older. Both cohorts were randomized to either receiver IV placement guided by ultrasound or via the traditional palpation method.

First-attempt success was greater in the ultrasound-guided IV placement group (85.4%) compared to those in the traditional IV group (45.8%). The ultrasonographically-guided group also had fewer median attempts (1) compared to the traditional group (2).

Parents also indicated they preferred lines placed using ultrasound over the traditional method when asked to score their satisfaction.

The researchers noted that nurses and physicians alike had high rates of first-attempt success. The rates were so successful among nurses that CHOP’s Emergency Department created an ultrasound-guided IV line placement training program for nurses.

"In our study, ultrasound-guided intravenous lines remained in place longer than traditional insertion, without an increase in complications," said Joseph J. Zorc, MD, emergency medicine physician at CHOP and co-senior author of the study, in a prepared statement. "These results may be used to update guidelines for intravenous line access in children in an effort to limit the number of needle sticks they experience."