Ultrasonographic Guidance to Improve First-Attempt Success in Children With Predicted Difficult Intravenous Access in the Emergency Department: A Randomized Controlled Trial
Ultrasonographic Guidance to Improve First-Attempt Success in Children With Predicted Difficult Intravenous Access in the Emergency Department: A Randomized Controlled Trial
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DOI：
10.1016/j.annemergmed.2019.02.019
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发表时间：
2019-07-01
影响因子：
6.2
通讯作者：
Zorc, Joseph J.
中科院分区：
文献类型：
--
作者：
Vinograd, Alexandra M.;Chen, Aaron E.;Zorc, Joseph J.
研究目的：我们确定超声引导下的静脉输液管放置是否可以将预计静脉输液困难的儿童的首次尝试成功率提高20%。次要目的包括确定超声引导下的静脉导管放置是否减少了尝试次数，提高了进入时间或家长满意度，或影响静脉导管的存活率和并发症。方法：这是一个前瞻性的，在城市三级护理儿科急诊科进行的一项随机对照试验，纳入了需要静脉输液的儿童的便利样本，这些儿童预计难以根据先前验证的评分确定静脉通路。参与者被随机分配到传统的或超声引导下的静脉输液管放置在第一次尝试和分层年龄为0至3岁与3 years.Results：一百六十七名患者被招募和随机分配到传统的静脉输液管或护理束与一个多学科的团队训练，将超声引导下的静脉输液管。超声引导静脉置管组（n = 83）的首次尝试成功率高于传统静脉置管组（n = 84）（85.4% vs 45.8%;相对风险1.9; 95%置信区间[CI] 1.5 - 2.4）。超声引导静脉输液管放置组的尝试次数少于传统静脉输液管组（中位数1 vs 2;中位数差异1; 95% CI 0.8 - 1.2），从随机化到静脉输液管冲洗的时间更短（中位数14分钟[四分位数间距11 - 20] vs 28分钟[四分位数间距16 - 42]）。Kaplan-Meier生存分析表明，超声引导静脉输液管的生存时间长于传统静脉输液管（中位7.3天[95% CI 3.7 - 9.5] vs 2.3天[95% CI 1.8 - 3.3]）。两组之间的并发症没有差异。父母更满意超声引导静脉输液管placement.Conclusion：超声引导静脉输液管放置在儿童与预测困难的静脉通路改善首次尝试成功和静脉输液管寿命时，由一个团队的训练有素的供应商进行。
Study objective: We determine whether ultrasonographically guided intravenous line placement improves the rate of first-attempt success by 20% for children with predicted difficult intravenous access. Secondary objectives included determining whether ultrasonographically guided intravenous line placement reduces the attempt number, improves time to access or parental satisfaction, or affects intravenous line survival and complications.Methods: This was a prospective, randomized controlled trial conducted in an urban tertiary care pediatric emergency department that enrolled a convenience sample of children requiring an intravenous line and who were predicted to have difficult intravenous access according to a previously validated score. Participants were randomized to traditional or ultrasonographically guided intravenous line placement on first attempt and stratified by aged 0 to 3 versus older than 3 years.Results: One hundred sixty-seven patients were enrolled and randomized to traditional intravenous line or to a care bundle with a multidisciplinary team trained to place ultrasonographically guided intravenous lines. First-attempt success was increased in the ultrasonographically guided intravenous line placement arm (n = 83) compared with the traditional intravenous line arm (n = 84) (85.4% versus 45.8%; relative risk 1.9; 95% confidence interval [CI] 1.5 to 2.4). There were fewer attempts in the ultrasonographically guided intravenous line placement arm than in the traditional intravenous line arm (median 1 versus 2; median difference 1; 95% CI 0.8 to 1.2) and a shorter time from randomization to intravenous line flush (median 14 minutes [interquartile range 11 to 20] versus 28 minutes [interquartile range 16 to 42]). A Kaplan-Meier survival analysis demonstrated that ultrasonographically guided intravenous lines survived longer than traditional ones (median 7.3 days [95% CI 3.7 to 9.5] versus 2.3 days [95% CI 1.8 to 3.3]). There was no difference in complications between the groups. Parents were more satisfied with ultrasonographically guided intravenous line placement.Conclusion: Ultrasonographically guided intravenous line placement in children with predicted difficult intravenous access improved first-attempt success and intravenous line longevity when conducted by a team of trained providers.