{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T18:49:24Z","timestamp":1770749364575,"version":"3.50.0"},"reference-count":16,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2021,3,22]],"date-time":"2021-03-22T00:00:00Z","timestamp":1616371200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Delayed identification of infiltration and dysfunction of peripheral intravenous (PIV) access can lead to serious consequences during general anesthesia in children. This preliminary study aimed to describe the application of precordial Doppler ultrasound during general anesthesia in children to detect and confirm the correct PIV access and to evaluate the accuracy of this method.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This was a single-center, preliminary study that was conducted in children (&lt;18 years) who were scheduled for elective surgeries between October 2019 and March 2020. Rater anesthesiologists judged the change in precordial Doppler sound (S test) before and after injection of 0.5 mL\/kg of normal saline (NS) via PIV. Blood flow velocity before and after NS injection was recorded, and multiple cutoff points were set to analyze the accuracy of detecting the infiltration and dysfunction of PIV catheter (V test).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The total incidence of peripheral infiltration and dysfunction of PIV catheter was 7\/512 (1.4%). In the S test, the sensitivity, specificity, positive and negative likelihood ratios, and area under the receiver-operating characteristic curves (AUCs) were 5\/7 (71.4%; 95% confidence interval [CI], 29.0%\u201396.3%), 490\/505 (97.0%; 95% CI, 95.1%\u201398.3%), 24.0, 0.29, and 0.84, respectively. The V test showed that the reasonable threshold of blood flow velocity change was 1.0 m\/s, with sensitivity, specificity, positive and negative likelihood ratios, and AUC of 4\/7 (57.1%; 95% CI, 18.4%\u201390.1%), 489\/505 (96.8%; 95% CI, 94.9%\u201398.2%), 18.0 and 0.44, and 0.84, respectively.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This preliminary study demonstrated that precordial Doppler ultrasound is a feasible, easy-to-use, and noninvasive technique with good accuracy to confirm the correct PIV access during general anesthesia in children. However, its accuracy requires further evaluation.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0248999","type":"journal-article","created":{"date-parts":[[2021,3,22]],"date-time":"2021-03-22T17:24:52Z","timestamp":1616433892000},"page":"e0248999","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Introduction of precordial Doppler ultrasound to confirm correct peripheral venous access during general anesthesia in children: A preliminary study"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7136-9815","authenticated-orcid":true,"given":"Taiki","family":"Kojima","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kana","family":"Kitamura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shogo","family":"Ichiyanagi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fumio","family":"Watanabe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yukiko","family":"Yamaguchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emi","family":"Sato","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daisuke","family":"Tani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiromi","family":"Kako","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali I.","family":"Kandil","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sachiko","family":"Ohde","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitsunori","family":"Miyazu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,3,22]]},"reference":[{"key":"pone.0248999.ref001","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/j.jclinane.2015.07.004","article-title":"A simple diagnostic test to confirm correct intravascular placement of peripheral catheters in order to avoid extravasation","volume":"27","author":"K Ilan","year":"2015","journal-title":"J Clin Anesth"},{"key":"pone.0248999.ref002","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1016\/j.ijsu.2014.08.355","article-title":"Paediatric extravasation injuries: a review of 69 consecutive patients","volume":"12","author":"DL Ching","year":"2014","journal-title":"Int J Surg"},{"key":"pone.0248999.ref003","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s12887-018-1387-1","article-title":"Treating extravasation injuries in infants and young children: a scoping review and survey of UK NHS practice","volume":"19","author":"M Corbett","year":"2019","journal-title":"BMC Pediatr"},{"key":"pone.0248999.ref004","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1111\/anae.14124","article-title":"Accidental awareness during general anaesthesia\u2014a narrative review","volume":"73","author":"SR Tasbihgou","year":"2018","journal-title":"Anaesthesia"},{"key":"pone.0248999.ref005","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1111\/pan.13188","article-title":"Introduction of color-flow injection test to confirm intravascular location of peripherally placed intravenous catheters","volume":"27","author":"NK Gautam","year":"2017","journal-title":"Paediatr Anaesth"},{"key":"pone.0248999.ref006","doi-asserted-by":"crossref","first-page":"e836","DOI":"10.1097\/CCM.0000000000003916","article-title":"Ultrasonographic detection of micro-bubbles in the right atrium to confirm peripheral venous catheter position in children","volume":"47","author":"J Takeshita","year":"2019","journal-title":"Crit Care Med"},{"key":"pone.0248999.ref007","doi-asserted-by":"crossref","first-page":"1543","DOI":"10.1213\/01.ane.0000198665.84248.61","article-title":"Precordial Doppler probe placement for optimal detection of venous air embolism during craniotomy","volume":"102","author":"A Schubert","year":"2006","journal-title":"Anesth Analg"},{"key":"pone.0248999.ref008","doi-asserted-by":"crossref","first-page":"76","DOI":"10.4097\/kja.d.18.00252","article-title":"A novel use of the precordial Doppler for verification of central venous access","volume":"72","author":"MA Burbridge","year":"2019","journal-title":"Korean J Anesthesiol"},{"key":"pone.0248999.ref009","doi-asserted-by":"crossref","first-page":"h5527","DOI":"10.1136\/bmj.h5527","article-title":"STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies","volume":"351","author":"PM Bossuyt","year":"2015","journal-title":"BMJ"},{"key":"pone.0248999.ref010","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.jclinane.2012.06.018","article-title":"Peripheral intravenous catheter infiltration: anesthesia providers do not adhere to their own ideas of best practice","volume":"25","author":"RD Ball","year":"2013","journal-title":"J Clin Anesth"},{"key":"pone.0248999.ref011","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1016\/S0140-6736(05)66422-7","article-title":"Refining clinical diagnosis with likelihood ratios","volume":"365","author":"DA Grimes","year":"2005","journal-title":"Lancet"},{"key":"pone.0248999.ref012","first-page":"YE01","article-title":"Requirements for minimum sample size for sensitivity and specificity analysis","volume":"10","author":"MA Bujang","year":"2016","journal-title":"J Clin Diagn Res"},{"key":"pone.0248999.ref013","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1213\/ANE.0b013e318258023b","article-title":"Intravenous sodium bicarbonate verifies intravenous position of catheters in ventilated children","volume":"115","author":"I Keidan","year":"2012","journal-title":"Anesth Analg"},{"key":"pone.0248999.ref014","doi-asserted-by":"crossref","first-page":"1916","DOI":"10.1378\/chest.121.6.1916","article-title":"Multilevel likelihood ratios for identifying exudative pleural effusions","volume":"121","author":"JE Heffner","year":"2002","journal-title":"Chest"},{"key":"pone.0248999.ref015","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/j.acvd.2009.04.011","article-title":"Palliative procedures for congenital heart defects","volume":"102","author":"SM Yuan","year":"2009","journal-title":"Arch Cardiovasc Dis"},{"key":"pone.0248999.ref016","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1213\/ANE.0000000000000717","article-title":"Fontan physiology revisited","volume":"121","author":"M Jolley","year":"2015","journal-title":"Anesth Analg"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0248999","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,22]],"date-time":"2021-03-22T17:25:05Z","timestamp":1616433905000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0248999"}},"subtitle":[],"editor":[{"given":"Yutaka","family":"Kondo","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,3,22]]},"references-count":16,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3,22]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0248999","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,22]]}}}