Kacey Wiseman BSN, RN, CPN, VA-BC

John Pilcher BSN, RN, VA-BC, CRNI

A Retrospective Look at

Ultrasound Guided Peripheral IV Insertion in

the Pediatric

Population

Learning Objectives

Identify potential benefits and drawbacks of

Ultrasound Guided PIV’s.

Evaluate the potential for Ultrasound Guided PIV’s

in your institution.

Summarize current literature on Ultrasound Guided

PIV’s

Financial DisclosuresDisclosure of Relevant Financial Relationships

We have the following financial relationships to disclose:

John Pilcher• No Disclosures

• Employee of: Boston Children’s Hospital, Brigham and Women’s Hospital

Kacey Wiseman• No Disclosures

• Employee of: Boston Children’s Hospital

Disclosure of Off Label and/or Investigative UsesWe will not discuss off label use and/or investigate uses in this presentation.

John• Case Manager in many aspects of

social services

• Attended nursing school at John’s

Hopkins University

• 11 years of nursing experience

• Specialized in Vascular Access in

Adults and Children for past 6 years

Kacey• RN on a Surgical/Trauma/Burn Unit

for 6 years

• Began travel nursing

• Specialized in Vascular Access in

Pediatrics for past 3 years

A little bit about us…

Why Ultrasound (AGAIN…)?

Skill Level & Training

PICC Excellence

Computer based

modules

Computer Didactic

Blue Phantom

Hands on Practice

Successfully place 3

PIV’s in all age groups

with Preceptor

1:1 Instruction

Step 1 Step 2 Step 3

Boston Children’s HospitalLiterature

Blue Phantom

Short Didactic and

Practice

Step 1 and 2

Novice to Expert RN’sRN’s, Residents, Anesthesia

Mostly Novice

Definition of success – each article defines success in a different way

Mixed results, indications from literature.

Vessel preservation – planning for future PIV placement

Insert the title of your subtitle Here

36

232

442

ED ICU/ICP GENERAL INPATIENT

Total PIVs Placed

USG and Transillumination

0 10 20 30 40 50 60 70

USG

Transillumination

Average Length of Stay

SUCCESS RATES & INSERTION ATTEMPTS

Success Rate

80%

60 – 100%

Avg. Attempts

1st Attempt

68%

53 - 85%

1-4 Attempts

Success Rate

87%

2018

Avg. Attempts

1st Attempt

76%

21% 2 Attempts

1.28 Attempts

Literature Boston Children’s Hospital

Technique & Catheter Size

• Dynamic Needle Tip Positioning vs. Static

• One person self guided

• Two person self guided

• Two Person peer guided

• Short Axis vs. Long Axis

• Variety of catheter sizes and lengths

Literature

• One person self guided DNTP

• Short Axis

• Hold and Positioning

• Skin Marker

• 1.25” 24g and 1.75” 22g

Boston Children’s Hospital

Holding Techniques

Dwell TimesA Multi-Factoral Statistic…

2 Days

4 Days

LITERATURE

BCH

0 1 2 3 4 5

Literature Vs. Boston Children’s Hospital

Dwell Times Per Unit

0

1

2

3

4

5

6

7

ED ICU General Inpatient

4 Days1hr, 17min

6 Days8hrs, 36min

3 Days4hrs, 2min

1 Day

19hrs, 26min

3 Days

19hrs, 16min

2 Days

5hrs, 57min

A Closer Look….

Dwell Times for USG PIVs

0

10

20

30

40

50

60

70

> 24Hrs

1 Day 2Days

3Days

4Days

5Days

6Days

7Days

8Days

9Days

10Days

11Days

12Days

13Days

14Days

15Days

16Days

18Days

19Days

22Days

43Days

57

69

47

40

29 31

20

9 9 9 8 6 4 4 3 1 2 2 3 1 1

Clinical Indication to D/C PIV

36%

42%

22%

Insufficient Documentation

OtherComplications

FunctioningPIV D/C

Technological

“Wow Factor”

Satisfaction and Perception

Studies and anecdotal experience at Boston

Children’ s hospital show overall increased

satisfaction when using Ultrasound Guidance

to place PIV’s from patients, families and

multidisciplinary team.

Complications and Drawbacks

• Arterial Puncture

• Failure rate 25% 1st

48 hours

• Infiltration, Leaking,

Phlebitis

Literature• Artery/Nerve puncture

potential complication

• Infiltration, Phlebitis,

Leaking, Unable to flush

• Non-Compressible Vessels

• Decrease central line

placement - Service or

Disservice?

Boston

Children’s Hospital

Here’s why ultrasound…

• Decrease Central Lines

• Line holidays

• Lab Drawing PIVs

• Emergent Access

• Otherwise unobtainable

patients

Continued Data Collection

Will concurrent central access with a

PIV alter the total time a PIV functions

without complication?

Thank you

BibliographyAvelar, A. F., Peterlini, M. A., & Pedreira, M. D. (2015). Ultrasonography-Guided Peripheral Intravenous Access in Children. Journal of Infusion Nursing, 38(5), 320-327. doi:10.1097/na

n.0000000000000126

Bair, A. E., Rose, J. S., Vance, C. W., Andrada-Brown, E., & Kuppermann, N. (2008). Ultrasound-Assisted Peripheral Venous Access in Young Children: A Randomized Controlled

Trial and pilot Feasibility Study. Western Journal of Emergency Medicine, IX(4), 219-224.

Benkhadra, M., Collignon, M., Fournel, I., Oeuvrard, C., Rollin, P., Perrin, M., . . . Girard, C. (2012). Ultrasound guidance allows faster peripheral IV cannulation in children under 3

years of age with difficult venous access: A prospective randomized study. Pediatric Anesthesia, 22(5), 449-454. doi:10.1111/j.1460-9592.2012.03830.x

Curtis, S. J., Craig, W. R., Logue, E., Vandermeer, B., Hanson, A., & Klassen, T. (2015). Ultrasound or near-infrared vascular imaging to guide peripheral intravenous catheterization in

children: A pragmatic randomized controlled trial. Canadian Medical Association Journal, 187(8), 563-570. doi:10.1503/cmaj.141012

Elia, F., Ferrari, G., Molino, P., Converso, M., Filippi, G. D., Milan, A., & Aprà, F. (2012). Standard-length catheters vs long catheters in ultrasound-guided peripheral vein

cannulation. The American Journal of Emergency Medicine, 30(5), 712-716. doi:10.1016/j.ajem.2011.04.019

Elkhunovich, M., Barreras, J., Pinero, V. B., Ziv, N., Vaiyani, A., & Mailhot, T. (2017). The use of ultrasound for peripheral IV placement by vascular access team nurses at a tertiary

childrens hospital. The Journal of Vascular Access, 18(1), 57-63. doi:10.5301/jva.5000615

Fields, J. M., Dean, A. J., Todman, R. W., Au, A. K., Anderson, K. L., Ku, B. S., . . . Panebianco, N. L. (2012). The effect of vessel depth, diameter, and location on ultrasound-guided

peripheral intravenous catheter longevity. The American Journal of Emergency Medicine, 30(7), 1134-1140. doi:10.1016/j.ajem.2011.07.027

Gopalasingam, N., Obad, D. S., Kristensen, B. S., Lundgaard, P., Veien, M., Gjedsted, J., . . . Juhl-Olsen, P. (2017). Ultrasound-guidance outperforms the palpation technique for

peripheral venous catheterisation in anaesthetised toddlers: A randomised study. Acta Anaesthesiologica Scandinavica, 61(6), 601-608. doi:10.1111/aas.12901

BibliographyGottlieb, M., Holladay, D., & Peksa, G. D. (2018). Comparison of Short- vs Long-axis Technique for Ultrasound-guided Peripheral Line Placement: A Systematic Review and

Meta-analysis. Cureus. doi:10.7759/cureus.2718

Heinrichs, J., Fritze, Z., Vandermeer, B., Klassen, T., & Curtis, S. (2013). Ultrasonographically Guided Peripheral Intravenous Cannulation of Children and Adults: A Systematic

Review and meta-Analysis. Annals of Emergency Medicine, 61(4), 444-453. doi:10.1016/j.annemergmed.2012.11.014

Jeon, L. W. (2012, July 20). BD Task – 9-block design [Video File]. Retrieved from https://www.youtube.com/watch?v=VYObq3X-4Oc

Kanipe, W., Shobe, K., Li, Y., Kime, M., & Smith-Miller, C. A. (2018). Evaluating the Efficacy and Use of Vein Visualization Equipment Among Clinical Nurses in an Intermediate

Care Environment. Journal of Infusion Nursing, 41(4), 253-258. doi:10.1097/nan.0000000000000286

Larsen, P., Eldridge, D., Brinkley, J., Newton, D., Goff, D., Hartzog, T., . . . Perkin, R. (2010). Pediatric Peripheral Intravenous Access. Journal of Infusion Nursing, 33(4), 226-235.

doi:10.1097/nan.0b013e3181e3a0a8

Ng, C., Ng, L., & Kessler, D. O. (2017). Attitudes towards three ultrasound-guided vascular access techniques in a paediatric emergency department. British Journal of Nursing, 26(19).

doi:10.12968/bjon.2017.26.19.s26

Oakley, E., & Wong, A. (2010). Ultrasound-assisted peripheral vascular access in a paediatric ED. Emergency Medicine Australasia, 22(2), 166-170. doi:10.1111/j.1742-6723.2010.01281.x

Otani, T., Morikawa, Y., Hayakawa, I., Atsumi, Y., Tomari, K., Tomobe, Y., … Hataya, H. (2018). Ultrasound-guided peripheral intravenous access placement for children in the

emerrgency department. European Journal of Pediatrics. https://doi.org/10.1007/s00431-018-3201-3

Paladini, A., Chiaretti, A., Sellasie, K. W., Pittiruti, M., & Vento, G. (2018). Ultrasound-guided placement of long peripheral cannulas in children over the age of 10 years admitted to

the emergency department: A pilot study. BMJ Paediatrics Open, 2(1). doi:10.1136/bmjpo-2017-000244

BibliographySchnadower, D., Lin, S., Perera, P., Smerling, A., & Dayan, P. (2007). A Pilot Study of Ultrasound Analysis before Pediatric Peripheral Vein Cannulation Attempt. Academic Emergency

Medicine,14(5), 483-485. doi:10.1197/j.aem.2006.12.016

Smith, H. M., Kopp, S. L., Johnson, R. L., Long, T. R., Cerhan, J. H., & Hebl, J. R. (2012). Looking into Learning: Visuospatial and Psychomotor Predictors of Ultrasound-Guided

Procedural Performance. Regional Anesthesia and Pain Medicine, 37(4), 441-447. doi:10.1097/aap.0b013e318257a551

Triffterer, L., Marhofer, P., Willschke, H., Machata, A., Reichel, G., Benkoe, T., & Kettner, S. (2012). Ultrasound-guided cannulation of the great saphenous vein at the ankle in

infants. British Journal of Anaesthesia, 108(2), 290-294. doi:10.1093/bja/aer334

Vinograd, A. M., Zorc, J. J., Dean, A. J., Abbadessa, M. K., & Chen, A. E. (2017). First-Attempt Success, Longevity, and Complication Rates of Ultrasound-Guided Peripheral

Intravenous Catheters in Children. Pediatric Emergency Care, 1. doi:10.1097/pec.0000000000001063