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
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
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).
Can new technology improve success rates? Near-infrared LED Transillumination Vacuum Dressing Nitrate ointments Ultrasound
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?
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
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.
Results
Risk of PIVC Failure
Number of Attempts to Successful PIVC
Procedure Time
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.
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
Acknowledgements Dale Storie- librarian
COMMENTS, QUESTIONS OR DISCUSSION? THANK-YOU!
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