{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T07:41:14Z","timestamp":1792827674960,"version":"4.5.0"},"reference-count":35,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Pediatr"],"published-print":{"date-parts":[[2025,3,1]]},"abstract":"\n Importance<\/jats:title>\n Pediatric peripheral intravenous catheter (PIVC) insertion can be difficult and time-consuming, frequently requiring multiple insertion attempts and often resulting in increased anxiety, distress, and treatment avoidance among children and their families. Ultrasound-guided PIVC insertion is a superior alternative to standard technique (palpation and visualization) in high-risk patients.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To compare first-time insertion success of PIVCs inserted with ultrasound guidance compared with standard technique (palpation and visualization) across all risk categories in the general pediatric hospital population.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n An open-label, pragmatic, superiority, randomized clinical trial was conducted in an Australian quaternary pediatric hospital. Children (ages 0-18 years) requiring PIVC insertion were included between July 2021 and December 2022. One catheter was studied per patient, and analysis was by intention to treat. Data analysis was performed from April to October 2023.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Eligible children were randomly assigned (1:1 using computer-generated randomization and concealed allocation) to receive ultrasound-guided or standard PIVC insertion. Randomization was stratified by insertion difficulty (low, medium, or high risk) defined using a standardized tool.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was first-time insertion success. Secondary outcomes included number of insertion attempts, insertion failure, postinsertion complications, dwell time, patient and parent satisfaction, and health care costs.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 164 children were randomly assigned to ultrasound-guided insertion (n\u2009=\u200984) or standard care (n\u2009=\u200980), with 81 (96.4%) and 78 (97.5%) receiving their allocated intervention, respectively. The median (IQR) age was 24 (10-120) months, and 93 children (56.7%) were male. First-time insertion success was higher with ultrasound-guided PIVC insertion (72 children [85.7%]) compared with standard technique (26 children [32.5%]) (risk difference [RD], 53.6%; 95% CI, 41.7%-65.4%;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Ultrasound-guided insertion led to significantly greater first-time insertion success across all risk categories, with the following RDs: low risk, 30.8% (95% CI, 8.1%-53.5%); medium risk, 56.2% (95% CI, 37.1%-75.3%); and high risk, 69.6% (95% CI, 52.3%-87.0%). Ultrasound-guided PIVC insertion had higher immediate health care costs (between group difference in total mean cost per person, A$9.33; 95% credible interval, A$8.83-A$10.86 [US $5.83; 95% credible interval, $5.52-$6.78]).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion and Relevance<\/jats:title>\n These findings suggest that ultrasound-guided PIVC insertion improves first-time insertion success across all risk categories in pediatrics, supporting the widespread adoption of ultrasound-guided PIVC insertion in children.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n anzctr.org.au Identifier:\n ACTRN12621000206820<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamapediatrics.2024.5581","type":"journal-article","created":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T11:32:41Z","timestamp":1737977561000},"page":"255","source":"Crossref","is-referenced-by-count":28,"title":["First-Attempt Success in Ultrasound-Guided vs Standard Peripheral Intravenous Catheter Insertion"],"prefix":"10.1001","volume":"179","author":[{"given":"Tricia M.","family":"Kleidon","sequence":"first","affiliation":[{"name":"Vascular Assessment and Management Service, Department of Anaesthesia and Pain, Queensland Children\u2019s Hospital, Children\u2019s Health Queensland Hospital and Health Service, Queensland, Australia"},{"name":"Alliance for Vascular Access Teaching and Research, Schools of Nursing and Midwifery, and Pharmacy and Medical Sciences, Griffith University, Queensland, Australia"},{"name":"School of Nursing, Midwifery, and Social Work, University of Queensland, Brisbane, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica A.","family":"Schults","sequence":"additional","affiliation":[{"name":"Alliance for Vascular Access Teaching and Research, Schools of Nursing and Midwifery, and Pharmacy and Medical Sciences, Griffith University, Queensland, Australia"},{"name":"School of Nursing, Midwifery, and Social Work, University of Queensland, Brisbane, Australia"},{"name":"Herston Infectious Diseases Institute, Metro North Health, Queensland Health, Brisbane, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth H.","family":"Royle","sequence":"additional","affiliation":[{"name":"Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Gibson","sequence":"additional","affiliation":[{"name":"Vascular Assessment and Management Service, Department of Anaesthesia and Pain, Queensland Children\u2019s Hospital, Children\u2019s Health Queensland Hospital and Health Service, Queensland, Australia"},{"name":"School of Nursing, Midwifery, and Social Work, University of Queensland, Brisbane, Australia"},{"name":"Children\u2019s Health Research Centre, University of Queensland, Brisbane, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert S.","family":"Ware","sequence":"additional","affiliation":[{"name":"Alliance for Vascular Access Teaching and Research, Schools of Nursing and Midwifery, and Pharmacy and Medical Sciences, Griffith University, Queensland, Australia"},{"name":"Griffith Biostatistics Unit, Griffith Health, Griffith University, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Andresen","sequence":"additional","affiliation":[{"name":"Vascular Assessment and Management Service, Department of Anaesthesia and Pain, Queensland Children\u2019s Hospital, Children\u2019s Health Queensland Hospital and Health Service, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Cattanach","sequence":"additional","affiliation":[{"name":"Vascular Assessment and Management Service, Department of Anaesthesia and Pain, Queensland Children\u2019s Hospital, Children\u2019s Health Queensland Hospital and Health Service, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Dean","sequence":"additional","affiliation":[{"name":"Vascular Assessment and Management Service, Department of Anaesthesia and Pain, Queensland Children\u2019s Hospital, Children\u2019s Health Queensland Hospital and Health Service, Queensland, Australia"},{"name":"School of Nursing, Midwifery, and Social Work, University of Queensland, Brisbane, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen","family":"Pitt","sequence":"additional","affiliation":[{"name":"Vascular Assessment and Management Service, Department of Anaesthesia and Pain, Queensland Children\u2019s Hospital, Children\u2019s Health Queensland Hospital and Health Service, Queensland, Australia"},{"name":"School of Nursing, Midwifery, and Social Work, University of Queensland, Brisbane, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malanda","family":"Ramstedt","sequence":"additional","affiliation":[{"name":"Vascular Assessment and Management Service, Department of Anaesthesia and Pain, Queensland Children\u2019s Hospital, Children\u2019s Health Queensland Hospital and Health Service, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Byrnes","sequence":"additional","affiliation":[{"name":"Alliance for Vascular Access Teaching and Research, Schools of Nursing and Midwifery, and Pharmacy and Medical Sciences, Griffith University, Queensland, Australia"},{"name":"Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Nelmes","sequence":"additional","affiliation":[{"name":"Vascular Assessment and Management Service, Department of Anaesthesia and Pain, Queensland Children\u2019s Hospital, Children\u2019s Health Queensland Hospital and Health Service, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire M.","family":"Rickard","sequence":"additional","affiliation":[{"name":"Alliance for Vascular Access Teaching and Research, Schools of Nursing and Midwifery, and Pharmacy and Medical Sciences, Griffith University, Queensland, Australia"},{"name":"School of Nursing, Midwifery, and Social Work, University of Queensland, Brisbane, Australia"},{"name":"Herston Infectious Diseases Institute, Metro North Health, Queensland Health, Brisbane, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda J.","family":"Ullman","sequence":"additional","affiliation":[{"name":"Vascular Assessment and Management Service, Department of Anaesthesia and Pain, Queensland Children\u2019s Hospital, Children\u2019s Health Queensland Hospital and Health Service, Queensland, Australia"},{"name":"Alliance for Vascular Access Teaching and Research, Schools of Nursing and Midwifery, and Pharmacy and Medical Sciences, Griffith University, Queensland, Australia"},{"name":"School of Nursing, Midwifery, and Social Work, University of Queensland, Brisbane, Australia"},{"name":"Children\u2019s Health Research Centre, University of Queensland, Brisbane, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"key":"poi240101r2","doi-asserted-by":"publisher","first-page":"e18","DOI":"10.1016\/j.pedn.2019.09.023","article-title":"Global pediatric peripheral intravenous catheter practice and performance: a secondary analysis of 4206 catheters.","volume":"50","author":"Ullman","year":"2020","journal-title":"J Pediatr Nurs"},{"issue":"12","key":"poi240101r4","doi-asserted-by":"publisher","first-page":"742","DOI":"10.12788\/jhm.3718","article-title":"Techniques and technologies to improve peripheral intravenous catheter outcomes in pediatric patients: systematic review and meta-analysis.","volume":"16","author":"Kleidon","year":"2021","journal-title":"J Hosp Med"},{"issue":"6","key":"poi240101r5","doi-asserted-by":"publisher","first-page":"953","DOI":"10.1111\/jpc.15985","article-title":"Comparison of ultrasound-guided peripheral intravenous catheter insertion with landmark technique in paediatric patients: a systematic review and meta-analysis.","volume":"58","author":"Kleidon","year":"2022","journal-title":"J Paediatr Child Health"},{"issue":"4","key":"poi240101r6","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1097\/NAN.0000000000000377","article-title":"Reducing risks and improving vascular access outcomes.","volume":"43","author":"Morrell","year":"2020","journal-title":"J Infus Nurs"},{"issue":"17-18","key":"poi240101r7","doi-asserted-by":"publisher","first-page":"6690","DOI":"10.1111\/jocn.16759","article-title":"The parent, child and young person experience of difficult venous access and recommendations for clinical practice: a qualitative descriptive study.","volume":"32","author":"Sharp","year":"2023","journal-title":"J Clin Nurs"},{"issue":"5","key":"poi240101r8","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1177\/0009922811435164","article-title":"Peripheral intravenous access in pediatric inpatients.","volume":"51","author":"Reigart","year":"2012","journal-title":"Clin Pediatr (Phila)"},{"issue":"10","key":"poi240101r9","doi-asserted-by":"publisher","first-page":"1214","DOI":"10.1111\/jpc.14384","article-title":"Implementation of a paediatric peripheral intravenous catheter care bundle: a quality improvement initiative.","volume":"55","author":"Kleidon","year":"2019","journal-title":"J Paediatr Child Health"},{"issue":"1","key":"poi240101r10","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1186\/s12913-023-09499-0","article-title":"Improving difficult peripheral intravenous access requires thought, training and technology (DART3): a stepped-wedge, cluster randomised controlled trial protocol.","volume":"23","author":"Schults","year":"2023","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"poi240101r11","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1186\/s12913-022-07605-2","article-title":"Improving peripheral venous cannula insertion in children: a mixed methods study to develop the DIVA key.","volume":"22","author":"Schults","year":"2022","journal-title":"BMC Health Serv Res"},{"issue":"3","key":"poi240101r13","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1097\/NAN.0000000000000100","article-title":"Accepted but unacceptable: peripheral IV catheter failure.","volume":"38","author":"Helm","year":"2015","journal-title":"J Infus Nurs"},{"issue":"7","key":"poi240101r14","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1111\/pan.14438","article-title":"Clinical and demographic factors associated with pediatric difficult intravenous access in the operating room.","volume":"32","author":"Ballard","year":"2022","journal-title":"Paediatr Anaesth"},{"issue":"5","key":"poi240101r15","doi-asserted-by":"publisher","first-page":"904","DOI":"10.1177\/11297298211059648","article-title":"Defining difficult intravenous access (DIVA): a systematic review.","volume":"24","author":"Bahl","year":"2023","journal-title":"J Vasc Access"},{"issue":"3","key":"poi240101r16","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1097\/PEC.0b013e31819a8946","article-title":"Randomized controlled trial of ultrasound-guided peripheral intravenous catheter placement versus traditional techniques in difficult-access pediatric patients.","volume":"25","author":"Doniger","year":"2009","journal-title":"Pediatr Emerg Care"},{"issue":"1","key":"poi240101r17","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1186\/s13063-018-2946-3","article-title":"Expert versus generalist inserters for peripheral intravenous catheter insertion: a pilot randomised controlled trial.","volume":"19","author":"Marsh","year":"2018","journal-title":"Trials"},{"issue":"14","key":"poi240101r18","doi-asserted-by":"publisher","first-page":"S22","DOI":"10.12968\/bjon.2023.32.14.S22","article-title":"Ultrasound-guided PIVC insertion: a randomised controlled trial protocol.","volume":"32","author":"Kleidon","year":"2023","journal-title":"Br J Nurs"},{"issue":"5","key":"poi240101r19","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1111\/jnu.12505","article-title":"Difficult peripheral venous access in children: an international survey and critical appraisal of assessment tools and escalation pathways.","volume":"51","author":"Schults","year":"2019","journal-title":"J Nurs Scholarsh"},{"issue":"1S","key":"poi240101r21","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1097\/NAN.0000000000000532","article-title":"Infusion Therapy Standards of Practice, 9th Edition.","volume":"47","author":"Nickel","year":"2024","journal-title":"J Infus Nurs"},{"issue":"9","key":"poi240101r22","doi-asserted-by":"publisher","first-page":"e410","DOI":"10.1097\/PCC.0000000000002034","article-title":"Superiority of dynamic needle tip positioning for ultrasound-guided peripheral venous catheterization in patients younger than 2 years old: a randomized controlled trial.","volume":"20","author":"Takeshita","year":"2019","journal-title":"Pediatr Crit Care Med"},{"issue":"2","key":"poi240101r24","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2014a metadata-driven methodology and workflow process for providing translational research informatics support.","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform"},{"issue":"4","key":"poi240101r25","doi-asserted-by":"publisher","first-page":"366","DOI":"10.5301\/jva.5000574","article-title":"Prospective evaluation of the learning curve for ultrasound-guided peripheral intravenous catheter placement.","volume":"17","author":"Stolz","year":"2016","journal-title":"J Vasc Access"},{"issue":"12","key":"poi240101r26","doi-asserted-by":"publisher","first-page":"1508","DOI":"10.1111\/anae.14082","article-title":"Dynamic ultrasound-guided short-axis needle tip navigation technique vs. landmark technique for difficult saphenous vein access in children: a randomised study.","volume":"72","author":"Hanada","year":"2017","journal-title":"Anaesthesia"},{"issue":"1","key":"poi240101r27","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/j.annemergmed.2019.02.019","article-title":"Ultrasonographic guidance to improve first-attempt success in children with predicted difficult intravenous access in the emergency department: a randomized controlled trial.","volume":"74","author":"Vinograd","year":"2019","journal-title":"Ann Emerg Med"},{"issue":"8","key":"poi240101r29","doi-asserted-by":"publisher","first-page":"862","DOI":"10.1016\/j.jpain.2018.02.013","article-title":"The psychometric properties of the FLACC scale used to assess procedural pain.","volume":"19","author":"Crellin","year":"2018","journal-title":"J Pain"},{"issue":"1","key":"poi240101r30","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1097\/j.pain.0000000000001377","article-title":"Recommendations for selection of self-report pain intensity measures in children and adolescents: a systematic review and quality assessment of measurement properties.","volume":"160","author":"Birnie","year":"2019","journal-title":"Pain"},{"issue":"6","key":"poi240101r31","doi-asserted-by":"publisher","first-page":"1073","DOI":"10.1016\/j.jpainsymman.2010.08.016","article-title":"Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review.","volume":"41","author":"Hjermstad","year":"2011","journal-title":"J Pain Symptom Manage"},{"issue":"3","key":"poi240101r32","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1177\/1129729817747531","article-title":"Pain upon inserting a peripheral intravenous catheter: size does not matter.","volume":"19","author":"van Loon","year":"2018","journal-title":"J Vasc Access"},{"issue":"1","key":"poi240101r33","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12955-023-02217-8","article-title":"Health-related quality of life and experience measures, to assess patients\u2019 experiences of peripheral intravenous catheters: a secondary data analysis.","volume":"22","author":"Larsen","year":"2024","journal-title":"Health Qual Life Outcomes"},{"issue":"3","key":"poi240101r34","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD011429.pub2","article-title":"Vascular access specialist teams for device insertion and prevention of failure.","volume":"3","author":"Carr","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"poi240101r35","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1016\/j.bja.2018.04.047","article-title":"Comparison of ultrasound guidance with palpation and direct visualisation for peripheral vein cannulation in adult patients: a systematic review and meta-analysis.","volume":"121","author":"van Loon","year":"2018","journal-title":"Br J Anaesth"},{"key":"poi240101r20","volume-title":"Venous Access Devices (VADs)\u2014Insertion and Management of Peripheral and Central Venous Access Devices","author":"Children\u2019s Health Queensland","year":"2019"},{"key":"poi240101r23","volume-title":"Procedural Pain\u2014Non-Pharmacological Management","author":"Children\u2019s Health Queensland","year":"2019"},{"key":"poi240101r1","unstructured":"Australian Institute of Health and Welfare. Health of Children. Australian Institute of Health and Welfare; 2020. Accessed July 1, 2023. https:\/\/www.aihw.gov.au\/reports-data\/myhospitals\/sectors\/admitted-patients"},{"key":"poi240101r3","unstructured":"Future Market Insights Inc. Peripheral Intravenous Catheters Market. Future Market Insights Inc; 2023. Accessed October 1, 2023. https:\/\/www.futuremarketinsights.com\/reports\/peripheral-intravenous-catheter-market"},{"key":"poi240101r12","unstructured":"Australian Commission on Safety and Quality in Health Care. Management of Peripheral Intravenous Catheters: Clinical Care Standard. Australian Commission on Safety and Quality in Health Care; 2021. Accessed June 25, 2021. https:\/\/www.safetyandquality.gov.au\/sites\/default\/files\/2021-05\/management_of_peripheral_intravenous_catheters_clinical_care_standard_-_accessible_pdf.pdf"},{"key":"poi240101r28","unstructured":"Centers for Disease Control and Prevention. Summary of recommendations from the guidelines for the prevention of intravascular catheter-related infections. 2011. Updated 2017. Accessed December 12, 2024. https:\/\/www.cdc.gov\/infection-control\/hcp\/intravascular-catheter-related-infections\/summary-recommendations.html"}],"container-title":["JAMA Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamapediatrics\/articlepdf\/2829639\/jamapediatrics_kleidon_2025_oi_240101_1739908533.78486.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T11:04:14Z","timestamp":1740999854000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamapediatrics\/fullarticle\/2829639"}},"subtitle":["The EPIC Superiority Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2025,3,1]]},"references-count":35,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamapediatrics.2024.5581","relation":{},"ISSN":["2168-6203"],"issn-type":[{"value":"2168-6203","type":"print"}],"subject":[],"published":{"date-parts":[[2025,3,1]]}}}