Ultrasound-assisted Peripheral Vascular Access in a Paediatric ED

Objectives: To assess the implementation and utility of US for assisting peripheral venous access in a paediatric ED.

Methods: A prospective, observational study of a convenience sample comparing the landmark and US-guided technique for peripheral vascular access in children from July 2006 to February 2007. Clinicians involved under went 3 months of training in US physics and with practical models. Clinicians estimated the degree of difficulty of insertion (using a Likert scale) before each line placement. Data including time of procedure and success or failure were collected, using a standardized clinical record form, by an observing researcher.

Results: A total of 84 patients were enrolled. There were 61 line placement episodes in the landmark group (with 253 attempts), and 38 in the US group (with 90 attempts). US recorded slightly higher success per attempt overall (42% vs 38%, P=0.08), and performed better in the patients with difficult access (success 35% vs 18%, P=0.003). US attempts took longer than landmark attempts (2 min 15 s vs 4 min, P<0.001).

Conclusion: The US guidance may improve the success rate of peripheral vascular access in children rated to have difficult or very difficult vascular access.