Duration of preoperative clear fluid fasting and peripheral intravenous catheterization in children: A single‐center observational cohort study of 9693 patients

Abstract

Background Children routinely undergo inhalational induction of general anesthesia. Intravenous line placement typically occurs after induction of anesthesia and can be challenging, particularly in infants and young children. Aims We conducted a retrospective observational study to determine whether there was an association between clear liquid fasting time and the number of peripheral intravenous catheter insertion attempts in anesthetized children. The secondary aim was to identify factors associated with multiple attempts to insert intravenous lines. Methods After institutional research board approval, we retrieved a data set of all children between 0 months and 18 years who received general anesthesia at our hospital between January 1, 2016, and September 30, 2017. Data included age, gender, weight, race, ASA status, gestational age, number of peripheral intravenous catheter insertion attempts, any assistive device for insertion, and insertion site. Inclusion criteria were mask induction, ASA status 1 or 2, nonemergency, ambulatory surgical procedures, and placement of a single intravenous line during the anesthetic. Results A total of 9693 patients were included in the study. Of which 8869 patients required one insertion attempt and 824 underwent multiple insertion attempts. 50% of patients in the single insertion attempt group had clear liquid fasting time <6.9 hours compared to 51.8% of patients requiring multiple attempts. Logistic regression model adjusted for age, ASA status, gender, and BMI did not find an association between duration of clear liquid fasting time and rate of multiple insertion attempts for intravenous catheters (OR: 0.99, 95% CI: 0.98‐1.01, P = .47). Conclusion Clear liquid fasting time was not associated with multiple insertion attempts for intravenous line insertion in children receiving general anesthesia. Factors such as patient age, ethnicity, time of day of induction of anesthesia, and American Society of Anesthesiologists Physical Status classification show a greater association with the risk of multiple intravenous line insertion attempts.

Clinical and demographic factors associated with pediatric difficult intravenous access in the operating room

“…2 However, Yen and colleagues reported that darker skin shade was a predictor for pediatric DVA in the ED, while Galvez and colleagues reported that Black race was associated with pediatric DVA in the OR. 9,12 We were unable to determine the darkness of skin color due to the retrospective nature of our study and recognize that patients who identify as Black may have variation in skin color. It is unknown if the association of Black race with DVA is due to the darkness of skin color causing difficulty in seeing veins or to other factors associated with racial health disparities.…”

“…Third, we did not adjust for fasting status as a factor for difficult vascular access; however, Galvez did not find an association between fasting status and multiple IV insertions. 9 Fourth, presence of patient comorbidities (prematurity, congenital heart disease, and renal disease) were based on ICD-9/10-CM billing codes associated with the patient's medical record so there is a chance of misclassification bias. 26 Fifth, only the method used for the successful IV attempt is documented in our EMR.…”

“…5 Most of the literature on children with DVA has originated from the care provided in the Emergency Department (ED) 5,6 with few studies on children undergoing procedures in the operating room (OR). 2,[7][8][9][10] In the OR environment, most children are fasting but are also often anesthetized with anesthetic gases before IV catheter placement, potentially improving insertion through immobilization and venodilation. But this also results in a critical patient safety period where children are prone to hypotension and airway obstruction without IV access.…”

“…5,11 Previously reported risk factors for DVA in children include age less than 1 year old, female sex, darker skin color, Black race, obesity, prematurity, end stage renal disease, congenital heart disease, higher American Society of Anesthesiology (ASA) physical status, and emergency surgery. 2,[7][8][9][10][12][13][14] However, these studies have not accounted for the use of ultrasound in obtaining vascular access and its association with DVA. Ultrasound-guided intravenous catheter insertion (USGIV) is a relatively new technique that has been shown to increase success rates and decrease time to cannulation in pediatric patients with DVA.…”

“Mining large data on small veins to inform pediatric perioperative difficult intravenous access”

“…The study by Ballard et al is a welcome addition to the limited yet growing body of literature on difficult venous access in children undergoing anesthesia, as most studies of difficult venous access in children have been conducted in the emergency department or inpatient settings 3,4,6 . Earlier studies in anesthetized children have identified several factors associated with difficult venous access, including obesity, patient age and race, time of day of induction of anesthesia, and American Society of Anesthesiologists (ASA) Physical Status classification 4,7,8 . Ballard et al 5 report similar findings, such as non‐Hispanic Black race/ethnicity, younger age, higher body mass index, higher ASA status, and otolaryngology procedures being associated with higher odds of difficult venous access for children undergoing anesthesia.…”