Objectives: To determine whether peripheral veins can be detected by ultrasound (US) and to determine vein characteristics, as measured by US, that are associated with successful peripheral venous (PV) catheterization in young children. Methods:The authors conducted an observational study in the pediatric emergency department (ED), with a convenience sample of children younger than 7 years. They evaluated attempts at PV catheterization in two groups on the basis of the visibility and palpability of the patients' veins: 1) clinically apparent (visible or palpable) and 2) not clinically apparent (nonvisible and nonpalpable). The authors obtained sonographic measurements in a transverse view (vertical diameter, circumference, and area) and in a longitudinal view (maximal uninterrupted length). Practitioners blinded to the US images then attempted to catheterize veins in the usual manner. The proportion of clinically apparent veins and the proportion of veins that were successfully catheterized that were identified by US were assessed, and the association between ultrasonographic vein measurements and success at catheterization, controlling for possible confounders, was determined.Results: The authors assessed 120 attempts (90 clinically apparent and 30 not clinically apparent) at PV catheterization in 83 patients. US detected all 90 clinically apparent veins, and cannulation success rate was 62/90 (69%). In the not clinically apparent vein group, the rate of success was only 3/30 (10%), and US detected all successfully catheterized veins. In no instance was cannulation successful when the vein was not detected by US. Maximal vein length in longitudinal view was an independent predictor of cannulation success in multivariate analysis.Conclusions: Ultrasound appears to be capable of detecting peripheral veins in children younger than 7 years of age, with lack of US vein visualization likely leading to unsuccessful PV placement. Greater vein length visualization may be a useful predictor of successful PV catheterization. ACADEMIC EMERGENCY MEDICINE 2007; 14:483-485 ª 2007 by the Society for Academic Emergency MedicineKeywords: ultrasonography, catheterization, peripheral venous, child, emergency medicine A lthough ultrasonographic guidance has gained acceptance for central-line and peripherally inserted central venous catheter placement in both adults and children, 1-4 the use of ultrasound (US) for peripheral venous (PV) catheterization has received limited attention. [5][6][7] To the best of our knowledge, there are no published studies describing the role of US for PV catheterization in children. Our specific aims were 1) to determine whether peripheral veins can be detected by US in traditional sites used for PV catheterization in young children and 2) to determine whether there are vein characteristics as measured by US that are associated with successful PV catheterization in young children presenting to the pediatric ED. METHODS Study DesignThis was an observational study. The Columbia University Instit...

BackgroundBowel and bladder problems affect more than 50% of people with Multiple Sclerosis (MS). These problems have a large impact on quality of life and place a significant burden on health systems.ObjectivesThis study aimed to ascertain the frequency of bladder and bowel problems in a select Australian MS cohort and to investigate the relationships between level of disability, bladder and bowel problems, and fatigue.MethodsQuestionnaires on the nature and severity of MS symptoms were distributed to clients attending an Australian MS centre. Log-binomial regression and multiple linear regression models were used to investigate relationships between disability, fatigue, and bladder and bowel problems.Results and conclusionsOf 167 questionnaires distributed, 136 were completed. Bladder problems were reported by 87 (74.4%) respondents, whilst 66 (48.9%) experienced functional constipation and 43 (31.9%) faecal incontinence. This frequency in our select Australian MS population is similar to that reported globally. There was a significant correlation between level of disability and: bladder problems (p = 0.015), faecal incontinence (p = 0.001), fatigue (p<0.001) and constipation (p = 0.016, relative risk: 1.16). Further investigation into the causal relationships between various MS symptoms may be beneficial in the development of novel therapeutic strategies for people with MS.

Ultrasound appears to be capable of detecting peripheral veins in children younger than 7 years of age, with lack of US vein visualization likely leading to unsuccessful PV placement. Greater vein length visualization may be a useful predictor of successful PV catheterization.

Objective The goal of this study was to assess the accuracy of ultrasound-measured optic nerve sheath diameter (ONSD) as a screen for ventriculoperitoneal shunt failure. Methods We prospectively enrolled a convenience sample of children presenting to the ED with suspected shunt failure. The ONSD was measured by ultrasound and compared with computed tomography/magnetic resonance imaging (CT/MRI) and neurosurgical impression. We defined shunt failure on ultrasound as an ONSD greater than 4.0 mm in infants 12 months and younger or greater than 4.5 mm in children older than 12 months. A single emergency radiologist at our institution read all CTs and MRIs for categorical determination of shunt failure. We defined shunt failure based on neurosurgical impression as a decision to admit and perform shunt revision. We report test characteristics and 95% confidence intervals of ONSD as a predictor for shunt failure. Results We enrolled 32 subjects. The sensitivities of ONSD compared with CT/MRI and neurosurgical impression, 60.0% and 75.0%, respectively, were low. However, the negative predictive values of ONSD compared with CT/MRI and neurosurgical impression were 90.0% and 95.0%, respectively. Conclusions Optic nerve sonography may be a useful tool to identify children presenting with suspected ventriculoperitoneal shunt failure who do not require further imaging. This would reduce the use of CT scan and exposure to ionizing radiation in children with suspected shunt malfunction who do not require neurosurgical intervention. Consideration of additional risk factors and a larger sample size may yield stronger results.