Obtaining Successful IV Placement in Pediatric Patients: The Number of IV Attempts by Age Comparison

Background:

Most pediatric patients admitted to inpatient wards require peripheral intravenous (PIV) access for the administration of fluids, medications, or other intravenous therapy. Even though peripheral intravenous insertion can be painful, time‐consuming, and often difficult, it is an essential procedure for most hospitalized pediatric patients and, therefore, should be further studied and understood.

Methods:

A convenience sample of 593 patients was collected over a 15‐month period from 2 teaching hospitals. Patients needing intravenous access between 7 AM and 11 PM Monday through Friday (with the exception of holidays) were identified by registered nurses (RNs) on the inpatient wards. Patients were considered eligible if they were under 18 years of age and required intravenous access; however, patients currently having a permanent central line, patients transferred from the neonatal intensive care unit prior to observation, and non‐English‐speaking patients were excluded. Patients meeting inclusion criteria were consented and enrolled. Data were collected from the first attempt until PIV access was obtained or until orders were written to discontinue the PIV attempts. A data collection tool was developed, and the following data were collected: basic demographics and patient diagnoses from the patient's medical record, the total number of PIV attempts, and total procedure time.

Results:

For the total of 593 subjects, 554 successfully achieved IV placement (93%). However, only 49% were successful on the first stick and 22% on the second. For the remaining 29%, multiple sticks were required, with 1 subject requiring 15 sticks to achieve placement. Infants less than a year oid required more attempts than older children. Infants experiencing one‐stick placement were 40% versus 53% for older children. Additional detailed results will be presented.

Conclusions:

The first IV placement attempt in pediatric patients resulted in success less than 50% of the time. Additionally, more than 25% of the patients required 3 or more sticks to establish IV access. Infants seem to be at a higher risk for numerous IV attempts than were older patients. There is a need to develop alternative approaches to deliver fluid and medication in patients who do not have an IV established after 2 attempts.

Author Disclosure:

T. Hartzog, none; K. Chamberlain, none; K. Freeland, none; E. O'Brien, none; R. Reigart, none.