Peripheral intravenous cannulation in infants and children

Pediatric peripheral intravenous cannulation (PIVC) is a common procedure for hospitalized infants or children using parenteral therapy such as intravenous (IV) fluids, medications, and blood products. Approximately 13%–20% of patients who visit the pediatric emergency department have a peripheral IV system injected.^, Many studies have reported factors associated with difficult IV access.^{,  ,  ,}  Lee et al. reported a first-time insertion success (FTIS) rate of 91.7%. They found that the rate of difficult IV access decreased as children's age increased. The success rate of IV access was the highest when placed in the hand, followed by the elbow and foot, and the success rate of IV catheter placement could be improved by experienced providers. Petroski et al. reported that IV access in the hand and lower extremity was associated with greater odds of difficult access than that in the antecubital fossa. Carr et al. reported a FTIS rate of 73%, with 15% requiring a second attempt and 9% requiring ≥3 attempts. Clinicians with greater confidence and experience will improve the FTIS rate. Chu et al. reported that the failure rate of PIVC in the infant group was higher than that in other age groups. Neonatal infection (high procalcitonin) was associated with an increased failure rate. The success rate was positively associated with the seniority of the operators; however, the failure rate could increase with the lack of sustained practice.

The difficult IV access (DIVA) score had been created (3 points for prematurity, 3 for younger than 1 year, 1 for 1–2 years of age, 2 for vein not palpable, and 2 for vein not visible) as a clinical prediction rule that was useful for predicting success or failure of PIVC. The score ranged from 0 to 10; a DIVA score of ≥4 were more than 50% likely to have failed PIVC on the first attempt.

A near-infrared light device (Vein Viewer®, Luminex Corporation, Memphis, TN, USA) that delineated the running course of subcutaneous veins had been used to improve the rate of successful first-attempt placement of IV catheters. Kim et al. reported that the overall FTIS rate was not statistically significant between the Vein Viewer® group and the control group; however, the Vein Viewer® facilitated peripheral venous access for pediatric patients in whom IV access was difficult.

In conclusion, PIVC is a common procedure for hospitalized pediatric patients. The failure rate of PIVC in the infant group is higher than that in other age groups. The success rate is positively associated with the seniority of the operators, and the failure rate will increase with lack of sustained practice. A near-infrared light device (Vein Viewer®) can increase the success rate of difficult PIVC.