References
Ultrasound-detected venous changes associated with peripheral intravenous placement in children
Abstract
HIGHLIGHTS
Ultrasound shows several venous changes in pediatric PIV-containing veins.
Changes were visualized by ultrasound in the absence of physical exam findings.
Venous luminal narrowing, wall thickening, and thrombosis may explain PIV failure.
Background:
Peripheral intravenous catheters (PIVs) are routinely used for venous access in hospitalized pediatric patients to administer fluids and medications and to aspirate blood. Unfortunately, PIVs do not remain functional for the entire duration of intravascular need. We hypothesized that PIV malfunction may be related to venous changes that can be visualized with ultrasound (US) imaging. The purpose of this study was to describe and document such changes in pediatric patients.
Methods:
This Institutional Review Board-approved study was performed at a tertiary pediatric medical center. Patients underwent US scans of their PIV-containing veins, documenting venous characteristics such as depth, diameter, wall thickness, blood flow, valves, branch points, and presence of thrombus. Patient demographics and PIV characteristics were also recorded.
Results:
Data from 30 patients including 12 males and 18 females with a mean age of 11 years were analyzed. Mean venous depth and diameter were 2.07 ± 0.13 and 2.02 ± 0.18 mm, respectively. Mean PIV dwell time at time of evaluation was 3.3 days. PIV-associated venous changes were seen in 73% of accessed veins and included lumen narrowing (47%), wall thickening (33%), presence of thrombus (20%), and absence of blood flow around the PIV tip (40%).
Conclusion:
PIV-associated venous changes are seen with US in the majority of pediatric patients with indwelling PIVs but are not necessarily appreciated on physical exam. These changes may help explain the high rate of pediatric PIV device failure. Given the small sample size, further investigation is needed to better characterize PIV-associated venous changes in children.
Stable, reliable venous access is required to administer intravenous fluids and medications as well as to obtain blood samples for laboratory testing in hospitalized pediatric patients.1 Accordingly, venous access is frequently practiced at every pediatric hospital.2,3 Vascular access includes peripheral intravenous catheters (PIVs), central venous catheters, and peripherally inserted central catheters (PICCs). Of these 3 options, PIV access is the simplest, least invasive, least expensive, and most commonly used method for short-term intravenous therapy needs.4
PIVs are nearly ubiquitous medical devices employed in caring for hospitalized pediatric patients.5 These are typically placed in the lower arm (hand or antecubital veins), although placement in upper arm veins and saphenous veins of the leg is also common. Other locations may be used as required by the patient's size and venous availability. In routine clinical practice, PIVs are used for short-term needs because studies have shown that rates of thrombophlebitis and device failure increase with longer dwell times.6 Although the average duration of pediatric hospitalization is approximately 96 hours, a recent study of 458 hospitalized pediatric patients showed the median PIV dwell time was only 29 hours, suggesting that multiple PIVs may be needed during a single admission.5,7 A study of PIVs placed in a pediatric emergency department showed that approximately 25% of these PIVs failed due to infiltration, dislodgement, phlebitis, or other causes, and nearly half of these required replacement.5 Another study of children presenting for anesthesia and surgery showed that approximately one third of PIVs were dysfunctional based on pain with palpation at insertion site, difficulty with injection of saline, infiltration at insertion site, or poor to no flow.8 Studies have also shown that PIV-associated complications, including malposition, infiltration, and extravasation, are more common in PIVs placed in children than in those placed in adult patients.9,10,11,12,13
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