Efficacy of PIVC insertion using Imaging technology compared to Combined palpation and visualization.
The EPIC randomised controlled trial.
Tricia M Kleidon RN MNursPrac, Jessica Schults RN PhD, Ruth H Royle MEcon, Robert S Ware PhD, Joshua Byrnes PhD, Claire M Rickard RN PhD, Amanda J Ullman RN PhD
Background
Paediatric peripheral intravenous catheter (PIVC) insertion can be difficult and time-consuming. Ultrasound-guided PIVC insertion is a superior alternative to standard (palpation and visualisation) technique in high-risk patients.
Purpose
•The aim of this study was to test the effect of ultrasound-guided PIVC insertion compared to standard technique using palpation and visualisation only, across all risk categories in the general paediatric hospital population.
•Our primary hypothesis was children who have their PIVC inserted with ultrasound-guidance (USG) will have increased first attempt success compared to landmark PIVC insertion (standard care).
•Our secondary hypotheses Children who have their PIVC inserted with USG compared to standard technique will have decreased PIVC insertion failure, prolonged dwell, and reduced pain on insertion.
Methods
•Design/setting:
•A randomized controlled trial (July 2021 - December 2022)
•In a quaternary paediatric hospital, Brisbane, Australia.
•Participants:
•Eligibility: Patients aged 0 to 18 years requiring insertion of PIVC. PIVC inserted in awake/conscious state, e.g. maintaining own airway.
•Exclusion criteria: Patients were excluded if palliative, unable to provide consent (under care of social services, non-English speaking without an interpreter) previous enrolment in this study, or previously documented as high-risk DIVA that has required USG for successful PIVC insertion in the past.
•Interventions:
•Computer based randomisation in 1:1 ratio to receive a Standard technique or Ultrasound-guided PIVC insertion (see Figure 1)
•Stratified by DIVA key (see figure 2).
•One catheter was studied per patient.
•Outcomes:
•Primary – First time insertion success.
•Secondary – Number of insertion attempts, total PIVC insertion failure, all cause PIVC failure, patient reported pain on insertion, parent satisfaction with insertion, PIVC postinsertion failure and healthcare costs.
Conclusion
Ultrasound-guidance for PIVC insertion improved first-time PIVC insertion success across all risk categories in children
