RCT - Ultrasound Guided IV in Children

Written by Clay Smith

Spoon Feed
Ultrasound (U/S) guided IVs were more successful on first-stick than traditional in children with predicted difficult IV access.

Why does this matter?
U/S guided IV has become the go-to method for difficult IV access in adults. But does it work in children?

POCUS to poke ‘em
This was a RCT that enrolled 167 children with predicted difficult IV access. Those in the U/S group had marked improvement in first-stick success, 85.4% vs. 45.8%; RR1.9 (95% CI, 1.5 - 2.4); NNT = 2.5. The U/S group was a team of trained proceduralists. For secondary outcomes, U/S needed fewer attempts (median 1 vs 2), took half as long (14 vs 28 minutes), and lasted 5 days longer (7.3 vs 2.3 days). U/S had no increase in complications. Needless to say, this was unblinded. The usual IVs were mostly 25mm length; U/S IVs were 45mm. This was a single center, and success depends on training and experience, which varies widely. They intended to enroll 93 per group but stopped early because U/S guided access became standard of care in this center. Results were still statistically significant. It appears U/S is the way to go not only in adults but in children with difficult IV access.

Source
Ultrasonographic Guidance to Improve First-Attempt Success in Children With Predicted Difficult Intravenous Access in the Emergency Department: A Randomized Controlled Trial. Ann Emerg Med. 2019 May 21. pii: S0196-0644(19)30141-6. doi: 10.1016/j.annemergmed.2019.02.019. [Epub ahead of print]

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