PERIPHERAL INTRAVENOUS CATHETER PROBLEMS IN INFANTS AND CHILDREN PRESENTING FOR ANESTHESIA AND SURGERY.

Abstract

Background: Anesthesia providers frequently rely upon in-situ peripheral intravenous catheters (IVs) during the perioperative care of pediatric patients. IV dysfunction can result in complications including inability to administer medications for resuscitation, extravasation of tissue-toxic medications, and incomplete induction of anesthesia. This study was performed to prospectively assess the frequency of IV dysfunction in children presenting for anesthesia care.

Methods: A survey of IV patency and integrity was completed in patients less than 18 years of age arriving at the preoperative holding area for anesthesia evaluation. Prior to the induction of anesthesia, an anesthesiologist examined the IV for patency and evidence of infiltration. Demographic information, catheter site and size, condition of skin, elapsed time since insertion, and hospital site of catheter insertion were recorded.

Results: Over a 14-month period, 108 IVs were evaluated in 106 patients. One or more problems were identified with 35% of the IVs. Problems included erythema or pain to palpation at insertion site (29%), difficulty with injection of saline (45%), pain on injection of saline (50%), infiltrate at insertion site (13%), no flow or poor flow to gravity (42%), and kinked catheter (11%). The frequency of IV dysfunction was higher in infants (50%), with 24 gauge catheters (59%), with lower extremity IVs (50%), and with IVs in place for more than 3 three days (75%).

Conclusions: Approximately one-third of pre-existing IVs were dysfunctional in children presenting for anesthesia and surgery. Inspection for the integrity of the IV should occur prior to and during use, and a plan should be in place for readily replacing the IV in cases of dysfunction or for using an alternative route for the induction of anesthesia.