Factors Affecting Peripheral Intravenous Catheter Placement During Pediatric Trauma Resuscitation

Alberto, Emily C.; Mastrianni, Angela; Sullivan, Travis M.; McCarthy, Kathleen H.; Milestone, Zachary P.; Chung, Lauren; Cha, Nicholas; Mapelli, Emily; Sippel, Genevieve J.; Marsic, Ivan; O’Connell, Karen; Sarcevic, Aleksandra; Burd, Randall S.

doi:10.1016/j.jss.2022.10.048

Cited by 5 publications

(5 citation statements)

References 19 publications

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“…While time to balanced transfusion has not specifically been associated with clinical outcomes, any delay in blood product resuscitation is known to be associated with worse outcomes in adults and children 23–25 . Younger children are even more prone to transfusion delays due to vascular access, making it even more important to remove any barriers to timely transfusion in this population 26 . Early versus delayed balanced resuscitation with CT has been associated with lower mortality in adults 27 …”

Section: Discussionmentioning

confidence: 99%

“…[23][24][25] Younger children are even more prone to transfusion delays due to vascular access, making it even more important to remove any barriers to timely transfusion in this population. 26 Early versus delayed balanced resuscitation with CT has been associated with lower mortality in adults. 27 Our secondary findings are similar to a recent TQIP study showing decreased 4-hour transfusion volumes and fewer ventilator days in injured children transfused with whole blood instead of component therapy alone.…”

Section: Discussionmentioning

confidence: 99%

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Balanced resuscitation with whole blood versus component therapy in critically injured preadolescent children: Getting there faster with fewer exposures

McLoughlin,

Josephson,

Neff

et al. 2023

J Trauma Acute Care Surg

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Purpose Balanced blood product resuscitation with red blood cells, plasma, and platelets can be achieved using whole blood (WB) or component therapy (CT). However, balanced resuscitation of younger children with severe traumatic hemorrhage may be complicated by delays in delivering all blood components and concerns regarding multiple product exposures. We hypothesized that WB achieves balanced resuscitation faster than CT, with fewer product exposures and improved clinical outcomes. Methods Children <12 years old receiving balanced resuscitation within four hours of arrival were identified from the 2017-2019 Trauma Quality Improvement Program database. Time to balanced resuscitation was defined as the time of initiation of WB or all three components. Patient characteristics, resuscitation details, and outcomes were compared between WB and CT groups. Time to balanced resuscitation was compared using Kaplan-Meier analysis and Cox regression modeling to adjust for covariates. Additional multivariable regression models compared number of transfusion exposures, intensive care unit (ICU) length of stay, and mortality. Results There were 390 patients (109 WB, 281 CT) with median age 7 years, 12% penetrating mechanism, 42% severe TBI, and 49% in-hospital mortality. Time to balanced resuscitation was shorter for WB vs. CT (median 28 vs. 87 minutes, hazard ratio [HR] 2.93, 95% confidence interval [CI] 2.31-3.72, p < 0.0001). WB patients received fewer transfusion exposures (mean 3.2 vs. 3.9, adjusted incidence rate ratio 0.82, 95% CI 0.72-0.92, p = 0.001) and lower total product volumes (50 vs. 85 mL/kg, p = 0.01). ICU stays trended shorter for WB vs. CT (median 10 vs. 12 days; adjusted HR 1.32, 95% CI 0.93-1.86), while in-hospital mortality was similar (50% vs. 45%, adjusted odds ratio 1.11, 95% CI 0.65-1.88). Conclusions In critically injured pre-adolescent children receiving emergent transfusion, WB was associated with faster time to balanced resuscitation, fewer transfusion exposures, lower blood product volumes, and a trend toward shorter ICU stays than CT. Study Type Original Research Level of Evidence 3, retrospective

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Balanced resuscitation with whole blood versus component therapy in critically injured preadolescent children: Getting there faster with fewer exposures

McLoughlin,

Josephson,

Neff

et al. 2023

J Trauma Acute Care Surg

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“…Prehospital management of the pediatric patient requiring DCR remains challenging for a number of reasons: (1) uncommon frequency of the event-of all injured children, the percentage requiring blood transfusion and massive transfusion approximately is 2.5% and 0.5%, respectively. 6 This corresponds to an average of 10 to 20 MTP activation from traumatic injury per year at large pediatric trauma centers, and far fewer at most lower volume centers; (2) relative emergency medical services (EMS) provider inexperience with this uncommon pediatric event leading to the delay in recognition and treatment of LTH; (3) intravenous access in children can be challenging; combined with the relative unfamiliarity of EMS providers with using intraosseous needle access in children, this can lead to delays in resuscitation 7 while access is being established; and (4) a paucity of quality research to establish evidence-based prehospital pediatric trauma management.…”

Section: Prehospital Management Of Pediatric Hemorrhagic Shockmentioning

confidence: 99%

Damage-control resuscitation in pediatric trauma: What you need to know

Russell

Leeper

Spinella

2023

J Trauma Acute Care Surg

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Damage-control resuscitation (DCR) consists of rapid control of bleeding, avoidance of hemodilution, acidosis, and hypothermia; early empiric balanced transfusions with red blood cells, plasma and platelets, or whole blood when available, and the use of intravenous or mechanical hemostatic adjuncts when indicated. The principles used in pediatric and adult trauma patients are quite similar. There are very important recognized physiologic differences in children with traumatic hemorrhagic shock that warrant slight variations in DCR. In pediatric trauma patients, early physiologic signs of shock may be different from adults and the early recognition of this is critical to enable prompt resuscitation and utilization of damage control principles. This review details the current principles of pediatric DCR based on the best available literature, expert consensus recommendations, and also describes a practical guide for implementation of DCR strategies for pediatric trauma patients.

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“…Peripheral intravenous catheter is the most commonly used peripheral indwelling needle in clinical nursing practice [ 1 ]. The peripheral intravenous catheter is a transfusion device with a length of 2 to 6 cm through the peripheral vein, and the end of the catheter is located in the peripheral vein [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics: a meta-analysis of randomized controlled trials

Li,

Zheng,

Chen

et al. 2024

BMC Pediatr

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Background It is still controversial for neonates or children to choose normal saline or heparin solution in the care of peripheral intravenous catheters. This meta-analysis aimed to evaluate the effects of heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics, to provide reliable evidence support for clinical care. Methods Two authors searched the PubMed, EMbase, Ovid Medline, Cochrane Library, Web of Science, CBM, WanFang Data and China National Knowledge Infrastructure (CNKI) databases for randomized controlled trial (RCT) of heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics until July 16, 2023. The bias of risk tool recommended by Cochrane was used for the quality evaluation of included RCTs. Meta-analysis was carried out by using RevMan 5.4 software. Results A total of 22 RCTs involving 3988 peripheral intravenous catheters were finally included. Compare with normal saline, heparin could significantly increase the catheter indwelling time (MD = 9.10, 95%CI:3.30 ~ 14.90). Subgroup analysis indicated that for compare with normal saline, heparin could significantly increase the catheter indwelling time in the neonate (MD = 9.63, 95%CI: 0.38 ~ 18.88) and neonate + children population (MD = 6.22, 95%CI:2.72 ~ 9.73, P < 0.001). Heparin could significantly reduce the incidence of catheter-associated complications (RR = 0.84, 95%CI: 0.70 ~ 0.95). Subgroup analysis indicated that heparin could significantly reduce the incidence of catheter-associated complications in the neonate (RR = 0.70, 95%CI: 0.61 ~ 0.89). There was no publication bias amongst the synthesized outcomes by Egger’s test (all P > 0.05). Conclusions Heparin may be worthy of being applicated in the neonate population in terms of prolonged indwelling time and less complications. Limited by the evidence quality, more studies from different area and populations with rigorous design are needed to investigate the role of heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics.

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Factors Affecting Peripheral Intravenous Catheter Placement During Pediatric Trauma Resuscitation

Cited by 5 publications

References 19 publications

Balanced resuscitation with whole blood versus component therapy in critically injured preadolescent children: Getting there faster with fewer exposures

Balanced resuscitation with whole blood versus component therapy in critically injured preadolescent children: Getting there faster with fewer exposures

Damage-control resuscitation in pediatric trauma: What you need to know

Heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics: a meta-analysis of randomized controlled trials

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