title: The use of the needle-free jet injection system with buffered lidocaine device does not change intravenous placement success in children in the emergency department.
abstract: OBJECTIVE
  The needle-free jet injection system with buffered lidocaine (J tip) has been shown to reduce pain for intravenous (IV) line insertion, but its relationship with successful IV placement has not been well studied. This study aimed to determine if J tip use is associated with improved first-attempt IV placement success in children.
  
  
  METHODS
  This was a retrospective cohort study of children ages 1 to 18 years with need for emergent IV placement. Approximately 300 children were selected from each of three separate age groups: 1 to 2, 3 to 6, and 7 to 18 years. The standard treatment group (no device) included children with IV insertions from January 2009 through January 2010 with no J tip. The J tip treatment group (device) included children with IV insertions from December 2010 through December 2011 who received J tips. Successful IV placement on first attempt was the primary outcome. A chi-square test was used to compare the proportion of first-attempt success and logistic regression was performed to assess the effect of device use and patient age, sex, and race on first-attempt success.
  
  
  RESULTS
  A total of 958 children were identified, 501 in the no-device group and 457 in the device group. The most common diagnoses were vomiting or dehydration (30.3%), trauma or burn (20.0%), and infection (15.5%). Overall, first-attempt success was 69.0% and was similar between the no-device (68.7%) and device (69.4%) groups (p = 0.81). No difference in first-attempt success with the use of the device was found in any of the age groups. Multivariate analysis found that only age of 1 to 2 years was associated with lower odds of first-attempt success when controlling for patient characteristics and device use.
  
  
  CONCLUSIONS
  The use of the J tip did not affect first-attempt success for IV placement in children.
authors.affiliation: The Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Maren M
authors.initials: MM
authors.lastname: Lunoe
authors.forename: Amy L
authors.initials: AL
authors.lastname: Drendel
authors.forename: David C
authors.initials: DC
authors.lastname: Brousseau
mesh_terms: D000293:Adolescent; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007223:Infant; D007277:Injections, Jet; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies
chemical_list: D008012:Lidocaine