title: Ultrasound guidance allows faster peripheral IV cannulation in children under 3 years of age with difficult venous access: a prospective randomized study.
abstract: OBJECTIVE
  Ultrasound-guided peripheral venous access (USG-PIVA) presents many advantages over the reference 'blind' technique in both adults and children in emergency situations.
  
  
  OBJECTIVE
  To compare USG-PIVA with the blind technique in children <3 years undergoing general anesthesia.
  
  
  METHODS
  After obtaining the approval of the ethics committee and informed consent from the parents, we included all children <3 years scheduled to undergo general anesthesia [surgery, magnetic resonance imaging (MRI)], who presented difficult venous access. The children were randomized into two groups: the US group (USG-PIVA) and the B group (blind). The primary endpoint was time to cannulation (from tourniquet placement to successful IV cannulation), compared between USG-PIVA group and B group by intention-to-treat analysis. Secondary outcomes were success rate at the first puncture, number of punctures, and diameter of the catheters. Cannulations requiring >15 min were considered as failures. In case of failure in group B, USG-PIVA was attempted for a further 15 min.
  
  
  RESULTS
  Twenty children were included in each group. Groups were comparable for sex, age, and BMI. Significant differences were observed in median time to cannulation (63.5 s vs 420.5 s, USG-PIVA vs B respectively, P < 0.001); median number of punctures (1 vs 2.5, USG-PIVA vs B, P = 0.004); and success rate at first cannulation (85% vs 35%, USG-PIVA vs B, P = 0.0012). In contrast, overall success rate did not differ significantly between groups (90% vs 85%, USG-PIVA vs B, P = 0.63).
  
  
  CONCLUSIONS
  Ultrasound-guided peripheral venous access leads to faster peripheral IV access and should therefore be recommended in children presenting with difficult venous access.
authors.affiliation: Department of Anesthesiology and Intensive Care, University Hospital Bocage, Dijon, France. mehdi.benkhadra@gmail.com
authors.forename: Mehdi
authors.initials: M
authors.lastname: Benkhadra
authors.forename: Mathieu
authors.initials: M
authors.lastname: Collignon
authors.forename: Isabelle
authors.initials: I
authors.lastname: Fournel
authors.forename: Christian
authors.initials: C
authors.lastname: Oeuvrard
authors.forename: Patricia
authors.initials: P
authors.lastname: Rollin
authors.forename: Murielle
authors.initials: M
authors.lastname: Perrin
authors.forename: François
authors.initials: F
authors.lastname: Volot
authors.forename: Claude
authors.initials: C
authors.lastname: Girard
mesh_terms: D000768:Anesthesia, General; D002406:Catheterization, Peripheral / Q000379:methods*; D002408:Catheters, Indwelling; D004203:Disinfection; D023381:Endpoint Determination; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D035002:Lower Extremity / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D018401:Sample Size; D016896:Treatment Outcome; D014463:Ultrasonography; D034941:Upper Extremity / Q000000981:diagnostic imaging; D014680:Veins / Q000000981:diagnostic imaging*