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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
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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
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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.
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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…
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Why Ultrasound (AGAIN…)?
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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
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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
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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
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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
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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
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Holding Techniques
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Dwell TimesA Multi-Factoral Statistic…
2 Days
4 Days
LITERATURE
BCH
0 1 2 3 4 5
Literature Vs. Boston Children’s Hospital
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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
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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
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Clinical Indication to D/C PIV
36%
42%
22%
Insufficient Documentation
OtherComplications
FunctioningPIV D/C
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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.
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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
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Here’s why ultrasound…
• Decrease Central Lines
• Line holidays
• Lab Drawing PIVs
• Emergent Access
• Otherwise unobtainable
patients
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Continued Data Collection
Will concurrent central access with a
PIV alter the total time a PIV functions
without complication?
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Thank you
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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
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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
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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).
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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
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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
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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
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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
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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