Skin Transillumination Improves Peripheral Vein Cannulation by Residents in Neonates: A Randomized Controlled Trial.

Neonatology Pub Date : 2024-05-16 DOI:10.1159/000538880
Samantha Hinterstein, Harald Ehrhardt, Klaus-Peter Zimmer, A. Windhorst, Judith Kappesser, Christiane Hermann, Rahel Schuler, Markus Waitz
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Abstract

INTRODUCTION Establishing peripheral vein access is challenging for pediatric residents and a painful procedure for neonates. We assessed the efficacy of a red light-emitting diode transilluminator during peripheral vein catheter insertion performed by pediatric residents. METHODS Patients were stratified by current weight (≤1,500 g, >1,500 g) and randomized to the transillumination or the control group. The first three attempts were performed by pediatric residents, followed by three attempts by a neonatologist. The primary outcome was success at first attempt. Secondary comparisons included time to successful insertion and overall success rates of residents and neonatologists. RESULTS A total of 559 procedures were analyzed. The success rate at resident's first attempt was 44/93 (47%) with transillumination versus 44/90 (49%) without transillumination (p = 0.88) in the strata ≤1,500 g and 103/188 (55%) with transillumination versus 64/188 (34%) without transillumination in the strata >1,500 g (p < 0.001). The overall success rate for residents was 86% in the transillumination versus 73% in the control group in the strata >1,500 g (p = 0.003) but not different in the strata ≤1,500 g (78/93 [84%] vs. 72/90 [80%], p = 0.57). There was no effect when the experience level of residents exceeded 6 months. Neonatologists' overall success rate and time to successful cannulation did not differ significantly in both weight strata. CONCLUSION Transillumination improves the first-attempt success rate of peripheral vein cannulation performed by pediatric residents in neonates >1,500 g, while no benefit was found in infants ≤1,500 g.
皮肤透照可改善住院医师为新生儿进行外周静脉插管的效果:随机对照试验
简介建立外周静脉通路对儿科住院医师来说是一项挑战,对新生儿来说则是一项痛苦的过程。我们评估了儿科住院医师在插入外周静脉导管时使用红色发光二极管透照器的效果。前三次尝试由儿科住院医生进行,随后由新生儿科医生进行三次尝试。主要结果是首次尝试成功。结果共分析了 559 例手术。在体重≤1,500 g 的分层中,住院医生首次尝试的成功率为 44/93 (47%),而未使用透视灯的成功率为 44/90 (49%)(P = 0.88);在体重大于 1,500 g 的分层中,使用透视灯的成功率为 103/188 (55%),而未使用透视灯的成功率为 64/188 (34%)(P < 0.001)。在体重大于 1,500 克的分层中,经光照组住院医师的总体成功率为 86%,而对照组为 73%(p = 0.003),但在体重小于 1,500 克的分层中没有差异(78/93 [84%] vs. 72/90 [80%],p = 0.57)。当住院医生的工作经验超过 6 个月时,没有影响。结论透照可提高儿科住院医师对体重大于 1500 克的新生儿进行外周静脉插管的首次尝试成功率,而对体重小于 1500 克的婴儿则无益处。
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