Comparison of peripheral cannula outcomes, ultrasound-guided placement of deep veins versus blind insertion of superficial veins in children aged 0–18 years: A retrospective study

Background: The clinical use of ultrasound has increased the chances of successful insertion of all venous access devices, including short peripheral cannulas (SPC) and long peripheral catheters (LPC). The aim of the study was to compare the clinical performance of peripheral cannulas inserted using the traditional “blind” technique versus those inserted with ultrasound guidance (US). Methods: In this retrospective study we compared 135 peripheral intravenous cannulations (PIVCs) with ultrasound guidance and 135 PIVCs with blind technique, inserted in children (0–18 years) in the emergency department. All devices were inserted using the catheter-over-needle technique. With the blind technique, superficial arm veins were cannulated using SPCs (1.9 cm, 24G; 2.5 cm, 22G; 3.2 cm, 20G), while with US, deeper non-palpable veins were accessed using SPCs of 3.2 cm, 24G; and LPCs of 6.4 cm, 22G; 6.4 cm, 20G. Results: The accesses were removed electively in 66% of US-PIVCs, with an average duration of the device of 5.3 ± 4.0 days, but only in 30% of Blind-PIVCs, which presented an average duration of 2.5 ± 1.8 days. The longest dwelling time (8.7 ± 5.1 days) was observed in 20G LPCs inserted with US into the basilic vein of the arm; among Blind-PIVCs, the longest duration (3.0 ± 2.1 days) was observed in 22G SPCs inserted into the cephalic vein at the forearm. The most commonly encountered complication in both groups was accidental dislodgment. Conclusions: PIVCs with ultrasound guidance were apparently more effective than the blind ones, reducing the number of successive cannulations. Additionally, LPCs, with their greater length compared to SPCs, have proven to be more durable and may be recommended as emergency venous access in children requiring peripheral access for 4–15 days. Dislodgement should be reduced by improving the securement of the device.