Ultrasound-guided peripheral intravenous cannulation (PIVC) of. review and meta-analysis

Transcription

1 Ultrasound-guided peripheral p intravenous cannulation (PIVC) of children and adults: A systematic review and meta-analysis Jeffrey Heinrichs, Zachary Fritz, Ben Vandermeer, Dr. Terry Klassen, Dr. Sarah Curtis

2 Peripheral Intravenous Catheter Placement Most commonly performed procedure Feared by both children and adults Pain & Anxiety Placement difficult in several populations Repeat attempts: Increase pain and anxiety experienced by the patient, families and health care providers Increases time required by healthcare workers and affects department flow increased cost

3 Success Rates with Traditional Method Traditional method : palpation and landmark guidance. Success rates adults :76% with first attempt and 98% after second attempt (Minville et al. 2006). First attempt success rates in children :53% to 75.6% (Lininger et al. 2003; Black et al. 2005).

4 Can new technology improve success rates? Near-infrared LED Transillumination Vacuum Dressing Nitrate ointments Ultrasound

5 PICO Patient/Problem Intervention Comparison Outcomes Design Patients requiring initiation of intravenous access through a PIVC Placement of a PIVC using ultrasoundguidance Placement of a PIVC using traditional method Failure of IV placement on first attempt Number of attempts to successful PIVC RCT Time to successful PIVC Secondary outcomes In patients requiring intravenous access, does the use of ultrasoundguidance improve the success of peripheral IV placement compared to the traditional method?

6 Study Flow 4664 items identified through database searching 10 items identified through other sources 3765 items after removing duplicates 3765 items screened 403 full-text articles assessed for eligibility 3379 items excluded based on abstract or title 17 added d from reference lists of articles included for meta-analysis 390 full text articles excluded 6 ultrasound trials 13 RCTs included 7 trials of other devices

7 Ti Trial lcharacteristics ti Number: 4 adult; 2 pediatric Setting: 4 in ED; 2 in OR. Trial size: n= 18 to n= 57. Ultrasound Operator: physician 3; nurse 3 Risk of bias assessment: 3 trials low risk 1 trial high risk 2 trials unclear.

8 Results

9 Risk of PIVC Failure

10 Number of Attempts to Successful PIVC

11 Procedure Time

12 Other Findings and Limitations Subgroup analysis within the adult studies suggests that ultrasoundguidance is of greater benefit in the ED than the OR. Differences in study setting, intervention provider, ultrasound technique, and study protocol contribute to point-estimate heterogeneity. Reporting quality among the included studies is generally poor. Th t f t di i There are too few studies in our review to investigate publication bias.

13 Conclusions Early evidence suggests ultrasound-guidance significantly decreases attempts and procedure times in the pediatric population. Currently there is no evidence that ultrasound- guidance decreases the failure rate, the number of attempts required, or the procedure time. More trials with larger numbers, proper randomization methods, and allocation concealment are needed in both adult and pediatric populations. p

14 Acknowledgements Dale Storie- librarian

15 COMMENTS, QUESTIONS OR DISCUSSION? THANK-YOU!

16 References Text Black K, Pusic M, Harmidy D, McGillivray D. Pediatric intravenous insertion in the emergency department: bevel up or bevel down? Pediatr Emerg Care 2005; 21(11): Lininger R. Pediatric Peripheral IV Insertion Success Rates. Pediatric Nursing 2003; 29(5): Minville V, Pianezza A, Asehnoune K, Cabardis S, Smail N. Prehospital intravenous line placement assessment in the French emergency system: a prospective study. Eur J Anaesthesiol 2006; 23(7): Images BMET WIKI, (2012), Ultrasound Transducer [ONLINE]. Available at: [Accessed 30 May 12] Lompoc Valley Medical Center, (2012), Operating Room [ONLINE]. Available at: [Accessed 30 May 12]. Luciano Santana-Cabrera, (2011), Figure 1: Entry via cephalic catheter (arrow) [ONLINE]. Available at: [Accessed 30 May 12]. News Editors, Global Post, (2011), Emergency_Room [ONLINE]. Available at: [Accessed 30 May 12]. Steve Whitehead, (2009), iv needle by casualty flickr [ONLINE]. Available at: [Accessed 30 May 12]. Wiki Doc, (2012), Intravenous Therapy [ONLINE]. Available at: [Accessed 30 May 12].