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A Systematic Review and Meta-analysis of New Interventions for Peripheral Intravenous Cannulation of Children

Heinrichs, Jeffrey BMSc*; Fritze, Zachary*; Klassen, Terry MD, MSc, FRCPC; Curtis, Sarah MD, MSc, FRCPC*

doi: 10.1097/PEC.0b013e3182999bcd
Review Article

Objective Establishing intravenous access in children is often challenging for health professionals. Multiple attempts at peripheral intravenous cannulation (PIVC) cause increased pain and delayed delivery of therapy. Our objective was to synthesize and evaluate the best evidence for novel interventions designed to improve pediatric PIVC.

Methods We searched for published and unpublished studies using MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, Web of Science,, and We included studies for meta-analysis if they were randomized, evaluated an intervention other than ultrasound, and reported on 1 of 3 primary outcome measures: success or failure of PIVC, number of attempts to successful cannulation, and procedure time. Two blinded reviewers assessed studies for eligibility and applied a data extraction form to those included. Study quality was assessed using the Cochrane Risk of Bias Tool.

Results Seven studies met the inclusion criteria. Randomized controlled trials (RCTs) of 3 different interventions were identified. A meta-analysis of 3 RCTs found that use of a transilluminator was associated with a decreased risk of first-attempt PIVC failure (risk ratio, 0.66; confidence interval, 0.41–1.06). Meta-analysis of 3 other RCTs found that near-infrared light devices do not impact the risk of first-attempt PIVC failure (risk ratio, 0.99; confidence interval, 0.74–1.33).

Conclusions Near-infrared light devices might be efficacious in selected subpopulations, but the available evidence does not support an overall benefit in the pediatric population. Transilluminators modestly improve pediatric PIVC, but the clinical significance of this benefit is questionable. Nitroglycerin ointments may increase the risk of PIVC failure and are associated with adverse effects.

From the *Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alberta, Edmonton, Alberta and †Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.

Disclosure: The authors declare no conflict of interest.

Reprints: Jeffrey Heinrichs, BMSc, Division of Pediatric Emergency Medicine, Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, Alberta, Canada T6G 1C9 (e-mail:

S.C. is supported by the CIHR.

© 2013 Lippincott Williams & Wilkins, Inc.