Dynamic ultrasound‐guided short‐axis needle tip navigation technique vs. landmark technique for difficult saphenous vein access in children: a randomised study

Abstract

Dynamic ultrasound-guided short-axis needle tip navigation is a novel technique for vascular access. After venipuncture, the needle and catheter are further advanced within the vessel lumen under real-time ultrasound guidance with constant visualisation of the needle tip in the short-axis view. This can minimise the risk of transfixing the cannulated vessel. We compared two techniques for non-visible saphenous vein cannulation under general anaesthesia in children weighing ≥ 3 kg and less than four years of age: dynamic ultrasound-guided short-axis needle tip navigation technique (ultrasound group) vs. landmark technique. Venous cannulation was performed by three experienced anaesthetists. The primary outcome measure was first-attempt success rate. Success rate within 10 min was a secondary outcome. A total of 102 patients were randomly allocated to either the ultrasound group or the landmark group. First-attempt success rate was 90% in the ultrasound group compared with 51% in the landmark group, p<0.001, difference 39%, 95% confidence interval (CI) of the difference 23-55%. Success rate within 10 min was 92% in the ultrasound group compared with 63% in the landmark group, p = 0.001, difference 29%, 95%CI of the difference 14-45%. We conclude that, when performed by experienced anaesthetists, the dynamic ultrasound-guided short-axis needle tip navigation technique improved non-visible saphenous vein cannulation in children compared with the landmark technique.

The effect of the use of the ultrasound-assisted technique versus traditional anatomic landmark approach for the saphenous venous cannulation in infants and toddlers with congenital heart disease: a randomized controlled trial

“…The choice of suitable veins and puncture methods is the critical point to facilitate peripheral IV placement. In addition to its shallow position, the saphenous vein may offer other features such as the greater vessel diameter and relatively xed location, which would make it a desirable option for IV placement for infants and toddlers [14]. Riera et al [9] recommended saphenous veins as a superior rst choice for IV cannulation in smaller children.…”

“…The sample size required was calculated on the basis of the success rate of the rst attempt. The previous study reported rst-attempt success rates of about 51% with the conventional method for saphenous venous cannulation [14]. We assumed that a 30% increase in the success rate of the rst attempt using the ultrasound technique should be signi cantly different compared with the traditional anatomic landmark approach.…”

Ultrasound‐guided techniques for peripheral intravenous placement in children with difficult venous access

“…In one tertiary academic pediatric institution, the entire procedure, including preparation and securing of the catheter, took an average of 2‐3 minutes in children with known features of DiVA . Similarly, higher first attempt success rates and a greater success of cannulation within 10 minutes were seen with US‐guided PIV cannulation attempted at the greater saphenous vein in children with DiVA compared with the landmark technique . Within the intensive care unit (ICU), US‐guided PIV placement facilitated subsequent peripheral inserted central catheter (PICC) placement with an 85% first attempt success rate, 95% overall success rate and 113 second total time to cannulation in children under 5 years of age .…”

“…These children were known to have had several failed PICC line attempts by experienced neonatal ICU nurses prior to the IR attempts . Despite a limited number of studies, the positive outcomes reported with US‐guided PIV placement under deep sedation or general anesthesia is encouraging …”

“…3 Similarly, higher first attempt success rates and a greater success of cannulation within 10 minutes were seen with US-guided PIV cannulation attempted at the greater saphenous vein in children with DiVA compared with the landmark technique. 16 Within the intensive care unit (ICU), US-guided PIV placement facilitated subsequent peripheral inserted central catheter (PICC) placement with an 85% first attempt success rate, 95% overall success rate and 113 second total time to cannulation in children under 5 years of age. 17 Similarly, interventional radiologists (IR) have reported excellent success rates and low complication rates when using US guidance to place PICC lines in neonates less than 1500 g under sedation or general anesthesia.…”