Ultrasound Guided Peripheral Intravenous Catheterization in the Pediatric Intensive Care Unit.

Clalit Health Services

Status: Unknown

Conditions: Peripheral Venous Cannulation

Treatments: Procedure: Traditional peripheral intravenous cannulation; Procedure: US guided dynamic needle tip positioning peripheral intravenous cannulation

Study type: Interventional

Funder types: Other

Identifiers

NCT04268225

0044-20-RMC

Details and patient eligibility

About

This is a randomized controlled prospective study. The purpose of this study is to compare a recently described technique of ultrasound (US) guided, dynamic needle tip positioning (DNTP), to the traditional technique of vein visualization and palpation for peripheral venous cannulation in intubated, sedated, and mechanically ventilated pediatric intensive care unit (PICU) patients. First attempt success rate, overall success rate within 3 attempts or 10 minutes (whichever comes first), number of attempts to success, time to success and cannula sizes will be compared between the 2 techniques. The study will include intubated, sedated and mechanically ventilated children, aged 0-18 years, hospitalized in the PICU who require peripheral intravenous (PIV) access for their management.

Enrollment: 90 estimated patients

Sex: All

Ages: Under 18 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Invasively ventilated
2. Younger than 18 years
3. Peripheral venous access required
4. Difficult intravenous access (DIVA) score of 4 or greater (on a scale of 0-10 with higher scores implying more difficult access)

Exclusion criteria

1. Refusal to consent
2. Research staff not available

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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90 participants in 2 patient groups

Ultrasound Guided Dynamic Needle Tip Positioning Technique

Experimental group

Description:

In this arm the US transducer, protected with a sterile cover and sterile gel will be placed in the short axis above the distal end of the selected vein, moving the probe to place the vein in the center of the ultrasound screen under the middle mark of the image. The catheter needle will be inserted close to the transducer. The needle tip will be visualized as a white dot on the ultrasound screen. Then, the transducer will be shifted slightly proximally until the white dot disappears from the screen. The needle and the transducer will be moved alternately toward the patient several times to visualize the needle tip in real time. After penetrating the anterior wall of the vein, these steps will be repeated a few more times with a smaller insertion angle to visualize the white dot in the vein. Finally, the outer catheter will be fully advanced and the needle core will be extracted.

Treatment:

Procedure: US guided dynamic needle tip positioning peripheral intravenous cannulation

Traditional insertion group

Active Comparator group

Description:

For traditional insertion technique insertion attempt will be blind or tactile. Otherwise, the same protocol and measurements as elaborated for the US guided group will be applied.

Treatment:

Procedure: Traditional peripheral intravenous cannulation