Placement of peripherally inserted central catheters in children guided by ultrasound: A prospective randomized, and controlled trial

Objective: To compare the use of vascular Doppler ultrasound with vein visualization and palpation for positioning peripherally inserted central catheters in children and to determine the influence of these methods on the success of the first puncture attempt, catheter positioning, and time required for the accomplishment.Design: A prospective randomized, controlled trial was conducted in a university hospital after ethical approval and was carried out among children (from birth to 18 yrs).Setting: São Paulo Hospital, São Paulo, Brazil.Patients: the sample comprises 42 peripherally inserted central catheters insertions allocated randomly into two groups: 1) an ultrasound group with 21 peripherally inserted central catheters guided by ultrasound; and 2) a control group with 21 catheters, in which the peripherally inserted central catheters were inserted using vein visualization and palpation.Interventions: the procedure was performed by two trained nurses using a standard protocol for peripherally inserted central catheter insertion and ultrasound use. Ultrasound group equipment was ILook25 (Sonosite, Bothell, WA) with a 25-mm, 10- to 15-MHz linear array transducer that reaches a 4-cm depth.Measurements and Main Results: Success in the first puncture attempt was higher (p=.003) in the ultrasound group (90.5%) than in the control group (47.6%). the catheter positioning success rate was 85.7% in the ultrasound group and 52.4% in the control group (p=.019). the median time spent on the procedure for the ultrasound group was 20 mins, whereas it was 50 mins for the control group (p=.001).Conclusion: the use of ultrasound increased the successful positioning of peripherally inserted central catheters in comparison with the venous anatomic landmark visualization and palpation technique and further optimized the time spent on the procedure. (Pediatr Crit Care Med 2012; 13: e282-e287)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal de São Paulo, Unifesp, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Enfermagem, São Paulo, BrazilUniversidade Federal de São Paulo, Unifesp, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Enfermagem, São Paulo, BrazilCNPq: 476295/2004-1Web of Scienc