Comparison of ultrasound-guided peripheral intravenous catheter insertion with landmark technique in paediatric patients: A systematic review and meta-analysis

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Kleidon, Tricia M
Schults, Jessica
Paterson, Rebecca
Rickard, Claire M
Ullman, Amanda J
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Background: Paediatric peripheral intravenous catheter (PIVC) insertion using traditional landmark insertion technique can be difficult. Aim: To systematically review the evidence comparing landmark to ultrasound guidance for PIVC insertion in general paediatric patients. Study design: Cochrane methodology to systematically search for randomised controlled trials comparing landmark to ultrasound-guided PIVC insertion. Data sources: Cochrane Central Register of Controlled Trials, US National Library of Medicine, Cumulative Index to Nursing and Allied Health, Embase. Data extraction: English-language, paediatric trials published after 2000, reporting first-attempt insertion success, overall PIVC insertion success, and/or time to insert were included. Central venous, non-venous and trials including only difficult intravenous access were excluded. Data were independently extracted and critiqued for quality using GRADE by three authors, and analysed using random effects, with results expressed as risk ratios (RR), mean differences (MD) and 95% confidence intervals (CI). Registration (CRD42020175314). Results: Of 70 titles identified, 5 studies (995 patients; 949 PIVCs) were included. There was no evidence of an effect of ultrasound guidance, compared to landmark, for first-attempt insertion success (RR 1.27; 95% CI 0.90–1.78; I2 = 88%; moderate quality evidence), overall insertion success (RR 1.14; 95% CI 0.90–1.44; I2 = 82%; low quality evidence), or time to insertion (mean difference −3.03 min; 95% CI −12.73 to 6.67; I2 = 92%; low quality evidence). Limitations: Small sample sizes, inconsistent outcomes and definitions in primary studies precluded definitive conclusions. Conclusions: Large clinical trials are needed to explore the effectiveness of ultrasound guidance for PIVC insertion in paediatrics. Specifically, children with difficult intravenous access might benefit most from this technology.

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Journal of Paediatrics and Child Health

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© 2022 The Authors. Journal of Paediatrics and Child Health published by John Wiley & Sons Australia, Ltd on behalf of Paediatrics and Child Health Division (The Royal Australasian College of Physicians). This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Kleidon, TM; Schults, J; Paterson, R; Rickard, CM; Ullman, AJ, Comparison of ultrasound-guided peripheral intravenous catheter insertion with landmark technique in paediatric patients: A systematic review and meta-analysis, Journal of Paediatrics and Child Health, 2022, 58 (6), pp. 953-961