Ultrasound-detected venous changes associated with peripheral intravenous placement in children

Abstract

HIGHLIGHTS Ultrasound shows several venous changes in pediatric PIV-containing veins. Changes were visualized by ultrasound in the absence of physical exam findings. Venous luminal narrowing, wall thickening, and thrombosis may explain PIV failure. Background: Peripheral intravenous catheters (PIVs) are routinely used for venous access in hospitalized pediatric patients to administer fluids and medications and to aspirate blood. Unfortunately, PIVs do not remain functional for the entire duration of intravascular need. We hypothesized that PIV malfunction may be related to venous changes that can be visualized with ultrasound (US) imaging. The purpose of this study was to describe and document such changes in pediatric patients. Methods: This Institutional Review Board-approved study was performed at a tertiary pediatric medical center. Patients underwent US scans of their PIV-containing veins, documenting venous characteristics such as depth, diameter, wall thickness, blood flow, valves, branch points, and presence of thrombus. Patient demographics and PIV characteristics were also recorded. Results: Data from 30 patients including 12 males and 18 females with a mean age of 11 years were analyzed. Mean venous depth and diameter were 2.07 ± 0.13 and 2.02 ± 0.18 mm, respectively. Mean PIV dwell time at time of evaluation was 3.3 days. PIV-associated venous changes were seen in 73% of accessed veins and included lumen narrowing (47%), wall thickening (33%), presence of thrombus (20%), and absence of blood flow around the PIV tip (40%). Conclusion: PIV-associated venous changes are seen with US in the majority of pediatric patients with indwelling PIVs but are not necessarily appreciated on physical exam. These changes may help explain the high rate of pediatric PIV device failure. Given the small sample size, further investigation is needed to better characterize PIV-associated venous changes in children.

Early recognition of peripheral intravenous catheter failure using serial ultrasonographic assessments

“…This current assessment method does not capture the evolution and progression of the cause that ultimately leads to catheter failure until it is too late. Some recent exploratory research using ultrasound technology determined that changes in the vein and soft tissue often occur after PIVC insertion [ 9 ]. Internally, venous and soft tissue changes may include: narrowing of the vein wall, vein wall thickening, subcutaneous edema, and presence of thrombus.…”

“…Internally, venous and soft tissue changes may include: narrowing of the vein wall, vein wall thickening, subcutaneous edema, and presence of thrombus. These changes can occur even in the absence of any clinical signs or symptoms evident on external exam [ 9 ]. While the literature has demonstrated that ultrasound is capable of identifying these subcutaneous changes, how well they correlate with impending or ongoing PIVC failure remains unclear.…”

Multicenter Study of Needle-Free Blood Collection System for Reducing Specimen Error and Intravenous Catheter Replacement

“…These changes lead to restricted blood flow at the IV catheter tip and the inability to access downstream collateral circulation because of venous valves preventing retrograde blood flow to the IV catheter. 10 , 11 …”

Identifying Predictors of Peripheral Intravenous Catheter Failure Using a Novel Combination of Clinical and Ultrasonographic Assessments

“…9 Prevention of these complications requires focusing on the changes beneath the skin that begin soon after PIVC insertion and progress over time. 10,11 Thus, investigating the anatomical changes at the subcutaneous level after PIVC insertion may unlock the secret to improved survivorship. Some recent exploratory data indicates that PIVC failure is due to ongoing in ammation of the vein.…”

“…12,13 Internally, venous changes can include narrowing of vein wall, wall thickening, and presence of thrombus even in the absence of any clinical signs and symptoms. 11 The incorporation of venous duplex ultrasonography to the site evaluation provides an objective means to characterize the ongoing changes underneath the skin and may help identify in ammatory variables that lead to PIVC failure.…”