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Superiority of Dynamic Needle Tip Positioning for Ultrasound-Guided Peripheral Venous Catheterization in Patients Younger Than 2 Years Old: A Randomized Controlled Trial*

Takeshita, Jun MD, PhD1,2; Yoshida, Takayuki MD, PhD2; Nakajima, Yasufumi MD, PhD2; Nakayama, Yoshinobu MD, PhD3; Nishiyama, Kei MD, PhD4; Ito, Yukie MD1; Shimizu, Yoshiyuki MD, PhD1; Takeuchi, Muneyuki MD, PhD1; Shime, Nobuaki MD, PhD5

Pediatric Critical Care Medicine: September 2019 - Volume 20 - Issue 9 - p e410-e414
doi: 10.1097/PCC.0000000000002034
Online Clinical Investigations
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Objectives: This study evaluated whether the dynamic needle tip positioning technique increased the success rate of ultrasound-guided peripheral venous catheterization in pediatric patients with a small-diameter vein compared with the static ultrasound-guided technique.

Design: Randomized controlled study.

Setting: Single institution, Osaka Women’s and Children’s Hospital.

Patients: The study population included 60 pediatric patients less than 2 years old who required peripheral venous catheterization in the PICU.

Interventions: Patients were randomly divided into the dynamic needle tip positioning (n = 30) or static group (n = 30). Each group received ultrasound-guided peripheral venous catheterization with or without dynamic needle tip positioning, respectively. The Fisher exact test, Kaplan-Meier curve plots, log-rank tests, and Mann-Whitney U test were used in the statistical analysis.

Measurements and Main Results: The first-attempt success rate was higher in the dynamic needle tip positioning group than in the static group (86.7% vs 60%; p = 0.039; relative risk = 1.44; 95% CI, 1.05–2.0). The overall success rate within 10 minutes was higher in the dynamic needle tip positioning group than in the static group (90% vs 63.3%; p = 0.03; relative risk = 1.42; 95% CI, 1.06–1.91). Significantly fewer attempts were made in the dynamic needle tip positioning group than in the static group (median [interquartile range, range] = 1 [1–1, 1–2] vs 1 [1–2, 1–3]; p = 0.013]). The median (interquartile range) catheterization times were 51.5 seconds (43–63 s) and 71.5 seconds (45–600 s) in the dynamic needle tip positioning and static groups, respectively (p = 0.01).

Conclusions: Dynamic needle tip positioning increased the first-attempt and overall success rates of ultrasound-guided peripheral venous catheterization in pediatric patients less than 2 years old.

1Department of Intensive Care Medicine, Osaka Prefectural Hospital Organization, Osaka Women’s and Children’s Hospital, Izumi, Osaka, Japan.

2Department of Anesthesiology, Kansai Medical University Hospital, Hirakata, Osaka, Japan.

3Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, City College of New York, New York, NY.

4Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, Mukaihata-cho, Fushimi-ku, Kyoto, Japan.

5Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Minami-ku, Hiroshima, Japan.

*See also p. 891.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

The authors have disclosed that they do not have any potential conflicts of interest.

This work was performed at Osaka Women’s and Children’s Hospital.

For information regarding this article, E-mail: t-k-s-t@koto.kpu-m.ac.jp

Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies