Ultrasound-Detected Venous Changes Associated with Peripheral Intravenous Placement in Children
Background: Peripheral intravenous catheters (PIVs) are routinely used for venous access in hospitalized pediatric patients to administer fluids and medications and to aspirate blood. Unfortunately, PIVs do not remain functional for the entire duration of intravascular need. We hypothesized that PIV malfunction may be related to venous changes that can be visualized with ultrasound (US) imaging. The purpose of this study was to describe and document such changes in pediatric patients. Methods: This Institutional Review Board-approved study was performed at a tertiary pediatric medical center. Patients underwent US scans of their PIV-containing veins, documenting venous characteristics such as depth, diameter, wall thickness, blood flow, valves, branch points, and presence of thrombus. Patient demographics and PIV characteristics were also recorded. Results: Data from 30 patients including 12 males and 18 females with a mean age of 11 years were analyzed. Mean venous depth and diameter were 2.07 ± 0.13 and 2.02 ± 0.18 mm, respectively. Mean PIV dwell time at time of evaluation was 3.3 days. PIV-associated venous changes were seen in 73% of accessed veins and included lumen narrowing (47%), wall thickening (33%), presence of thrombus (20%), and absence of blood flow around the PIV tip (40%). Conclusion: PIV-associated venous changes are seen with US in the majority of pediatric patients with indwelling PIVs but are not necessarily appreciated on physical exam. These changes may help explain the high rate of pediatric PIV device failure. Given the small sample size, further investigation is needed to better characterize PIV-associated venous changes in children.Abstract
Example patient showing how the data were recorded. An example patient with a 22-gauge PIV inserted at the right wrist. The 10-cm venous segment central to the PIV insertion site was measured and scanned with ultrasound. The image shows the PIV insertion site and location of 3 venous branch points and 1 venous valve seen on ultrasound imaging in this patient. There are no signs of phlebitis such as erythema, swelling, or other skin findings at the PIV insertion site.
Ultrasound image showing a venous branch. This is a cross-sectional view of a venous branch point joining a PIV-containing vein, 3.5 cm central to the PIV insertion site. The PIV-containing vein is marked with a yellow arrow and has a diameter of 4.39 mm. The joining venous branch is marked with a white arrow and has a diameter of 1.17 mm indicated with white stars.
Ultrasound image showing a venous valve. A, an example of a venous valve in longitudinal view located 4 cm central to the PIV tip. The diameter of the PIV-containing vein is 1.52 mm. B, an example of a venous valve in cross-sectional view located 8.5 cm central to the PIV tip. The diameter of the PIV-containing vein is 2.6 mm.
Ultrasound image showing venous collapse. A, longitudinal view of a PIV-containing vein showing venous collapse (white arrow) immediately following the PIV tip (yellow arrow). The vein lumen is difficult to visualize after the PIV tip and there is no detectable flow on ultrasound color Doppler. B, cross-sectional view of the same collapsed vein from A, with no discernable vein lumen at the PIV tip.
Ultrasound image showing venous wall thickening. This is a cross-sectional view showing wall thickening of a PIV-containing vein. The yellow arrow marks circumferential thickening of vein wall into the patent lumen and the white arrow points to outline the vein. This vein lumen was compressible under ultrasound distinguishing wall thickness from intraluminal thrombus.
Ultrasound imaging showing intraluminal venous thrombus. A, longitudinal view of an intraluminal thrombus in a PIV-containing vein. The yellow arrow marks the PIV tip and the white arrow marks the thrombus, which is a noncompressible echogenic area. B, cross-sectional view of an intramural thrombus in a PIV-containing vein. The white arrow marks the intramural thrombus, which is a noncompressible echogenic area, and the yellow arrow outlines the PIV-containing vein.
Ultrasound image showing restoration of venous blood flow following a branch point. A, longitudinal view of a PIV tip showing absent detectable flow on color Doppler. B, cross-sectional view (without color Doppler) of a branch point 0.5 cm after the PIV tip. The yellow arrow marks the PIV-containing vein; the hollow white arrow marks the joining point; and the solid white arrow marks the branch lumen. C, the same vein with detectable flow on color Doppler starting at the venous branch. The yellow arrow marks the PIV-containing vein; the hollow white arrow marks the joining point; and the solid white arrow is the branch lumen with detectable flow. D, cross-sectional view of same vein showing blood flow following the venous branch point at the 10-cm mark.
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