The primary objective is to determine whether the use of ultrasound guidance compared to standard IV access improves the proportion of successful IV placement on a first attempt for children in a pediatric emergency department who have predicted difficult access by a validated score. Secondary objectives include determining whether ultrasound-guided IV access lowers the overall number of IV attempts and/or reduces time to IV access. The investigators will also examine the duration of IV access and any complications related to IV access in both the traditional and ultrasound guided IV access group.
The proposed study is a randomized trial of ultrasound guided IV access compared to traditional IV access in patients determined to have difficult IV access based on the Difficult Intravenous Access (DIVA) scale. Patients enrolled in the study will be randomized to traditional IV access or ultrasound guided IV access. If randomized to ultrasound guided IV access, the IV will be placed under direct visualization. Following IV placement or when attempts at IV access have ceased, the patient and family will be asked to complete a series of questions related to their satisfaction regarding IV placement. The follow-up phase examining duration of the IV and any related complications will continue until the IV placed as part of the study has been removed.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
163
The ultrasound machine will be used to guide intravenous line placement in patients randomized to the ultrasound guided intravenous line group
Placement by experienced nurse using standard IV techniques
The Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Success of Initial IV Placement Attempt
Patients will be randomized to traditional IV placement or ultrasound guided IV placement immediately after enrollment. The IV will be placed directly following enrollment.
Time frame: Participants will be followed through the duration of emergency department stay, an expected average of 4 hours
Measure the overall number of IV attempts..
We will record the number of IV attempts made until a patient has a successfully placed IV or further attempts are aborted.
Time frame: Participants will be followed through the duration of emergency department stay, an expected average of 4 hours
Time to IV access.
The time from enrollment until successful IV access is obtained will be measured.
Time frame: Participants will be followed through the duration of emergency department stay, an expected average of 4 hours
Patient & family satisfaction with IV placement method.
A survey will be given to parents and patients over age 12 years to ask them about their experience with the IV placement.
Time frame: Participants will be followed through the duration of emergency department stay, an expected average of 4 hours
Compare the survival (in length of time) of IV access
We will track the IVs placed as part of the study through the electronic medical record to determine when and why they were removed and if there were any associated complications.
Time frame: Participants will be followed through the duration of hospital stay, expected average of 5 days
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