NM-260
Patterns and predictors of difficult intravenous access among children presenting for anesthesia.
1Patak L, 1Collins M, 2Groenewald C
1University of Washington, Seattle Children's Hospital, Seattle, WA, USA; 2Seattle Children's Hospital, Seattle, WA, United states
Introduction: Difficult peripheral intravenous (PIV) access is common among hospitalized children and those presenting to emergency departments and may increase health care costs.1,2 About 4 million children undergo surgery in the United States each year, yet the prevalence and predictors of difficult PIV placement among children presenting for anesthesia are unknown. The aim of this study was to describe patterns and predictors of difficult PIV placement among children presenting to a large, tertiary care children’s hospital in the United States.
Methods: We retrospectively analyzed all electronic medical record anesthesia cases from calendar years 2015-2016 from an academic, tertiary care, pediatric hospital. Difficult PIV placement was documented by anesthesiology providers. Time was measured in minutes from the time of entering the operating room to the time of PIV placement. Multivariate logistic regression analysis was used to determine whether age, sex, ASA status, and BMI was associated with difficult PIV placement.
Results: We identified 13,988 children 0-18 years of age, who underwent 17,950 anesthetics. Mean age was 8.1 years (standard deviation=5.9 years), and 56% were male. Overall, difficult PIV placement occurred in 1,002 (5.6%) of anesthetics. Patients with difficult PIV placement were younger (Mean=4.5 years) than those with easy PIV placement (Mean=8.4 years). For easy PIV placement, in-room to PIV placement time on average was longer for IV induction (8.6 minutes) versus mask induction (6.9 minutes), with difficult PIV’s requiring 46% more time on average with IV induction (21.2 minutes) versus mask induction (14.5 minutes). Overall, in-room to PIV placement time increased by 45% between second and third attempts (8.3 minutes vs. 12.0 minutes) and increased by 115% between second and >3 attempts. In our multivariate logistic regression models, younger age (odds ratio=0.9; 95% confidence interval 0.9-0.95, p<0.0001), increasing ASA status (OR=1.8; 95% CI 1.2-2.8), and higher BMI (OR=1.65; 95% CI 1.5-1.9) were associated with difficult PIV placement, while male sex (OR=0.8; 95% CI 0.6-0.9) was associated with easier PIV access.
Discussion: Previous work has established predictors for difficult PIV access in emergency departments. Our data suggests that decreasing age, female gender, increasing ASA status and increasing BMI should be considered when anticipating difficult PIV placement. Further, PIV placement requiring >2 attempts increases operating room time disproportionately as the number of attempts increases, which warrants investigation of whether implementing an evidence-based difficult PIV placement algorithm or competence using ultrasound guidance3 could impact the number of PIV placements performed with 1-2 attempts, irrespective of difficulty.
Conclusions: This retrospective study of 17,950 perioperative PIV placements establishes decreasing age, female gender, increasing ASA status and increasing BMI as predictors for difficult PIV access. The incidence of difficult PIV access in the perioperative setting is 5.6%.
References:
1. Goff DA, et al. Hosp Pediatr. 2013;3(3):185-91.
2. Petroski A, et al. J Vasc Access. 2015;16(6):521-26.
3. Duran-Gehring P, et al. J Ultrasound Med. 2016;35:2343-52.
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