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

Abstract

Peripheral intravenous placement in children can be challenging. Different techniques have been used to improve first pass success rates in children with known history of difficult venous access including surface landmarking, local warming, transillumination, ultrasonography, epidermal nitroglycerin, central venous access, intraosseous placement, and venous cutdown. Among these, ultrasound guidance has garnered the most interest among anesthesiologists. The cumulative literature surrounding the utility of ultrasound‐guided peripheral intravenous placement in children with and without difficult venous access has shown mixed results. Literature on the utility of ultrasound guidance for peripheral intravenous placement in children under deep sedation or anesthesia is limited but encouraging. This review summarizes the overall evidence for ultrasound‐guided peripheral intravenous placement in children with difficult venous access under deep sedation or general anesthesia. Furthermore, five subtly varying approaches to ultrasound‐guided peripheral intravenous placement with their advantages and disadvantages will be discussed. One of these five approaches is Dynamic Needle Tip Positioning. Utilizing a short axis out of plane ultrasound view, this promising technique allows for accurate needle tip localization and may increase the success rate of peripheral intravenous placement, even in small children, under deep sedation, or general anesthesia.

Pediatric anesthesia training to early career stage: Opportunities for firm foundations

“…In this regard, the mentor-mentee relationship between the authors of this paper has morphed and evolved with one of the more "senior" authors acquiring much new learning on ultrasound techniques from their mentee. 35…”

Ultrasound-guided peripheral vascular catheterization in pediatric patients: a narrative review

“…The most common peripheral intravenous access site is the dorsum of the hands or feet [16]. However, veins here are sometimes invisible and impalpable in pediatric patients, and 8-50% of catheterization attempts are associated with difficult venous access [17]. Venous diameter is an important independent predictor of catheterization success [18].…”

(Gefäß-)Anatomie im Neugeborenen-, Säuglings- und Kleinkindesalter

“…Das Verwenden von Ultraschall als Hilfsmittel für die periphervenöse Infusionsanlage ist ebenfalls möglich, ist jedoch bislang erfahrungsgemäß auf innerklinische Notfälle beschränkt [9,10]. Es bleibt wohl nur noch eine Frage der Zeit, bis der Ultraschall auch für schwierige Venenpunktionen präklinisch für Notärzte routinemäßig zum Einsatz kommt.…”

“…Hilfsmittel wie Gefäßultraschall oder Vaskuloskop können auch bei der ZVK-Anlage die entscheidenden Vorteile bringen [9] unter Berücksichtigung des zeitlichen Faktors. Das bedeutet, dass allein aus logistischen Gründen und weiteren Gegebenheiten diese Zugangsanlage innerklinisch erfolgen sollte.…”