Objectives Most children admitted to the emergency department (ED) require peripheral venous access (PVA), which is often difficult to perform or is unsuccessful. Ultrasound guidance helps with the placement of peripheral short cannulas (SC), but it has a limited cannula duration and a high risk of developing complications. The aim of this study was to compare success rates, dwell times and complications of peripheral venous long cannulas (LCs) inserted under ultrasound guidance with those of SCs in children.
Methods We prospectively studied all children older than 10 years of age admitted to our paediatric ED requiring PVA for an expected therapy of more than 5 days. In children with difficult intravenous access (DIVA), after two unsuccessful attempts of ‘blind’ placement of SCs, LCs (20 G, 8 cm) were inserted in the deep veins of arms using ultrasound guidance and the direct Seldinger technique.
Results LC placement (n=20) was successful in 100% of the cases. LC dwell time was 9.2±6.0 days, and most catheters were electively removed because they were no longer indicated. SC (n=20) placement showed a shorter dwell time duration, 3.2±2.1 days (p<0.0001), with complications occurring in 70% of the cases compared with 25% of cases in patients with LC (p=0.002). No local or major infectious complications were reported with LC placement.
Conclusions Ultrasound-guided placement of LC was associated with a low risk of catheter failure and complications compared with the ‘blind’ placement of SC. LC placement may be considered a valid option in patients with DIVA requiring PVA in paediatric ED or in children who are candidates for infusion therapy expected to last longer than 5 days.
- general paediatrics
- paediatric practice
- vascular disease
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Contributors AP, AC, KWS, MP and GV have made substantial contributions to the conception and design of the study protocol and have given final approval of the version to be published. AP was responsible for the statistical analysis, sample size calculation, randomisation process and final approval of the version to be published. AP and KWS carried out the recording of all the studied items of the randomised patients and have given final approval of the version to be published. AP, MP and GV wrote the manuscript with inputs from all authors.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Parental/guardian consent obtained.
Ethics approval Ethics Committee of Catholic University of Sacred Heart, Rome, Italy.
Provenance and peer review Not commissioned; externally peer reviewed.
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