B. Carr1, M. Ralls1, S. Gadepalli1, M. Jarboe1 1University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA
Introduction:
Securing adequate intravenous (IV) access for children undergoing surgical procedures can be a point of delay in the operating room (OR), leading to additional time under anesthesia and decreased OR efficiency. Furthermore, with each unsuccessful attempt, there is loss of potential sites, increasing difficulty. We examined outcomes of ultrasound-guided peripheral IV placement for patients with difficult veins, compared to preceding attempts. We hypothesized that use of ultrasound could consistently “rescue” difficult access situations despite previous attempts.
Methods:
This study included children who underwent surgery at C. S. Mott Children’s Hospital from 10/2015 to 05/2016, in whom securing IV access proved difficult for the anesthesia team. Patients underwent IV attempts by the anesthesia team using un-guided or near-infrared-guided methods at their discretion, according to the current institutional standard of care. Once anesthesia had attempted and failed, and felt that future success in IV access was unlikely, the surgical team offered to attempt IV placement under ultrasound guidance. Demographic data, time attempted by anesthesia, number of sticks attempted by anesthesia, and time and number of sticks required by the surgical team with ultrasound guidance were assessed. Data were prospectively recorded by the surgical team. Paired t-test was used to evaluate statistical significance, with p<0.05 considered significant.
Results:
Ten patients underwent IV attempts by both surgical and anesthesia teams. The median age was 19.5±70.2 months, the median weight was 9.8 kilograms (IQR 3.9-30.5), and 30 percent were female, with a median ASA score of 3 (IQR 2-4). The average time in the OR prior to incision was 60.3±18.6 minutes. Including five patients where anesthesia attempts took greater than 30 minutes, the average time spent by anesthesia teams was 27.7±15.3 minutes, while the average time spent for ultrasound-guided IV placement was 2.2±0.9 minutes (p=.0004). Including three patients that underwent more than 10 anesthesia attempts, the average number was 6.8±5.1, while the average number of ultrasound-guided attempts was 1.2±0.4(p=.0027).
Conclusion:
Cases of difficult intravenous access can have a significant impact on operating room efficiency and anesthesia time for the patient. Ultrasound-guided IV placement by experienced surgeons can dramatically decrease both the time and number of sticks required for success. Using ultrasound in the OR is a feasible strategy to “rescue” difficult access situations despite previous attempts, and may improve OR efficiency if employed early by appropriately trained surgeons.
