title: Ultrasound or near-infrared vascular imaging to guide peripheral intravenous catheterization in children: a pragmatic randomized controlled trial.
abstract: BACKGROUND
  Peripheral intravenous catheterization in children is challenging, and success rates vary greatly. We conducted a pragmatic randomized controlled trial to determine whether the use of ultrasound or near-infrared vascular imaging to guide catheterization would be more effective than the standard approach in achieving successful catheter placement on the first attempt.
  
  
  METHODS
  We enrolled a convenience sample of 418 children in a pediatric emergency department who required peripheral intravenous catheterization between June 2010 to August 2012. We stratified them by age (≤ 3 yr and > 3 yr) and randomly assigned them to undergo the procedure with the standard approach, or with the help of either ultrasound or near-infrared vascular imaging. The primary outcome was the proportion of patients who had successful placement of a catheter on the first attempt.
  
  
  RESULTS
  The rate of successful first attempts did not differ significantly between either of the 2 intervention groups and the standard approach group (differences in proportions -3.9%, 95% confidence interval [CI] -14.2% to 6.5%, for ultrasound imaging; -8.7%, 95% CI -19.4% to 1.9%, for near-infrared imaging). Among children 3 years and younger, the difference in success rates relative to standard care was also not significant for ultrasound imaging (-9.6%, 95% CI -29.8% to 10.6%), but it was significantly worse for near-infrared imaging (-20.1%, 95% CI -40.1% to -0.2%). Among children older than 3 years, the differences in success rates relative to standard care were smaller but not significant (-2.3%, 95% CI -13.6% to 9.0%, for ultrasound imaging; -4.1%, 95% CI -15.7% to 7.5%, for near-infrared imaging). None of the pairwise comparisons were statistically significant in any of the outcomes.
  
  
  CONCLUSIONS
  Neither technology improved first-attempt success rates of peripheral intravenous catheterization in children, even in the younger group. These findings do not support investment in these technologies for routine peripheral intravenous catheterization in children.
  
  
  BACKGROUND
  ClinicalTrials.gov, no. NCT01133652.
authors.affiliation: Department of Pediatrics (Curtis, Craig, Logue), University of Alberta; Alberta Research Centre for Health Evidence (Vandermeer); Department of Emergency Medicine (Hanson), University of Alberta; Women and Children's Health Research Institute (Curtis, Craig), Edmonton, Alta.; Manitoba Institute of Child Health and College of Medicine (Klassen), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man. scurtis@ualberta.ca.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Curtis
authors.affiliation: Department of Pediatrics (Curtis, Craig, Logue), University of Alberta; Alberta Research Centre for Health Evidence (Vandermeer); Department of Emergency Medicine (Hanson), University of Alberta; Women and Children's Health Research Institute (Curtis, Craig), Edmonton, Alta.; Manitoba Institute of Child Health and College of Medicine (Klassen), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.
authors.forename: William R
authors.initials: WR
authors.lastname: Craig
authors.affiliation: Department of Pediatrics (Curtis, Craig, Logue), University of Alberta; Alberta Research Centre for Health Evidence (Vandermeer); Department of Emergency Medicine (Hanson), University of Alberta; Women and Children's Health Research Institute (Curtis, Craig), Edmonton, Alta.; Manitoba Institute of Child Health and College of Medicine (Klassen), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.
authors.forename: Erin
authors.initials: E
authors.lastname: Logue
authors.affiliation: Department of Pediatrics (Curtis, Craig, Logue), University of Alberta; Alberta Research Centre for Health Evidence (Vandermeer); Department of Emergency Medicine (Hanson), University of Alberta; Women and Children's Health Research Institute (Curtis, Craig), Edmonton, Alta.; Manitoba Institute of Child Health and College of Medicine (Klassen), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.
authors.forename: Ben
authors.initials: B
authors.lastname: Vandermeer
authors.affiliation: Department of Pediatrics (Curtis, Craig, Logue), University of Alberta; Alberta Research Centre for Health Evidence (Vandermeer); Department of Emergency Medicine (Hanson), University of Alberta; Women and Children's Health Research Institute (Curtis, Craig), Edmonton, Alta.; Manitoba Institute of Child Health and College of Medicine (Klassen), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.
authors.forename: Amanda
authors.initials: A
authors.lastname: Hanson
authors.affiliation: Department of Pediatrics (Curtis, Craig, Logue), University of Alberta; Alberta Research Centre for Health Evidence (Vandermeer); Department of Emergency Medicine (Hanson), University of Alberta; Women and Children's Health Research Institute (Curtis, Craig), Edmonton, Alta.; Manitoba Institute of Child Health and College of Medicine (Klassen), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.
authors.forename: Terry
authors.initials: T
authors.lastname: Klassen
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000792:Angiography / Q000379:methods; D002406:Catheterization, Peripheral / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*