Evaluation of the difficulty of peripheral venous cannulation during anesthesia induction in children: Is DIVA score sufficient?

Abstract

Background: The primary objective of the present study was to determine the rate and the independent predictors of the difficult peripheral intravascular access (PIVA) in the operating room (OR). The secondary objective was to validate the ability of the difficult intravenous access (DIVA) scoring system in the detection of difficult PIVA in the operating room. Methods: In this prospective observational study, patients between 0 and 18 years old who were operated in the pediatric hospital were evaluated. Peripheral intravenous cannulation performed during inhalation induction in 1008 patients were recorded. The following data were collected: demographic characteristics, the presence of a chronic disease, the DIVA score, operating room temperature, the area of PIVA application, the duration of PIVA and the number of PIVA attempts. The independent determinants of the difficult PIVA were determined with multivariate logistic regression. Results: A total of 1008 patients (82% boys) with a median age of 4 (range 0.04–17 years) were included in the study. The median number of PIVA attempts was 1 whereas the median duration for successful PIVA was 15 s (range 4–2100). PIVA was successful at the first attempt in 75.3% of patients. Among patients who required more than two PIVA attempts, the most common adjunctive method was to seek help from another operator (80.8%). In the multivariable logistic regression model, only the presence of chronic disease, being underweight, and DIVA score ⩾4 (OR 6.355, CI 4.57–9.486) remained to be the significant determinants of difficult PIVA. Conclusion: The success rate of anesthesiologist-performed PIVA at the first attempt in the OR was 75.3%. Having a chronic disease, a DIVA score ⩾4 and being underweight appeared as the independent predictors for difficult PIVA.

Incidence of first attempt peripheral intravenous cannulation failure and its predictors among children admitted to Debre Tabor Referral Hospital, Northwest Ethiopia: institution based cross-sectional clinical study

“…This study showed that the first attempt peripheral intravenous cannulation failure rate was 34.83% which was in line with a rate reported in Bhutan (36%) 9 ; but it was lower than the study conducted in Netherland (55%) 4 and South-eastern United States 40% 12 . However, the finding of this study was higher than the findings from Australia (27%) 13 , Queensland (24.8%) 14 , Brazil (10.5%) 3 and Turkey (24.7%) 15 . This variation might be due to the presence/absence of training about IV cannulation, work experience of the clinicians, the presence/absence of assistive devices (like vein tourniquet), and nutritional status of children in the study settings.…”

Construction and Application of a Decision-Making Flowchart for Difficult Peripheral Intravenous Puncture in Children

“…It was also observed that 56.1% of children and adolescents who had veins difficult-to-see and 60.0% of patients who had veins not palpable were also punctured more than once for the procedure to be successful. Research indicates that patients who have a chronic disease have tortuous veins that are difficult to palpate, visualize and fragile due to continuous medication use, multiple punctures, and long hospital stays, compromising their venous system [35][36][38][39] . Pain, anxiety, fear and agitation presented by children before and during the procedure cause vasoconstriction, making it difficult to palpate and visualize the veins 1-2 .…”

Construção E Aplicação De Fluxograma Decisório Para Punção Intravenosa Periférica Difícil De Crianças

“…Observou-se ainda que 56,1% das crianças e adolescentes que tinham difícil visualização dos vasos e 60,0% dos pacientes que tinham difícil palpação dos vasos também foram puncionados mais de uma vez para o sucesso do procedimento. Pesquisas apontam que pacientes que possuem alguma doença crônica contêm vasos tortuosos, difíceis de palpar, de visualizar e frágeis devido ao uso contínuo de fármacos, múltiplas punções e longas internações hospitalares, ocasionando comprometimento de sua rede vascular [35][36][38][39] .. A dor, a ansiedade, o medo e a agitação apresentados pela criança antes e durante o procedimento ocasionam vasoconstrição periférica, dificultando a palpação e visualização das veias [1][2] .…”