Riera Antonio, Langhan Melissa, Northrup Veronika, Santucci Karen, Chen Lei
Pediatric Emergency Medicine, Yale-New Haven Children's Hospital, New Haven, CT 06504, USA.
Pediatr Emerg Care. 2011 Dec;27(12):1121-5. doi: 10.1097/PEC.0b013e31823ab926.
The primary objective of this study was to measure the width and depth of peripheral veins using bedside ultrasound in children younger than 3 years. Secondary objectives included the evaluation of other vein and patient characteristics that may affect intravenous (IV) site selection. Assessment of nursing preferences for peripheral IV site selection was performed.
Sixty children aged 0 to 3 years who presented to an urban pediatric emergency department were enrolled. Ultrasound measurements of the transverse diameter (width) and distance from the top of the vein to the skin (depth) were recorded. Upon examination, veins were categorized as visible, palpable, detectable only by ultrasound, or not detectable. Sixteen staff nurses rated the likelihood of successful IV placement among different peripheral veins.
The mean width of saphenous veins was significantly larger than that of hand veins (2.8 vs 1.8 mm, P < 0.0001). When comparing saphenous veins to antecubital veins, no significant difference was measured between the mean width (2.8 vs 2.8 mm). The mean depth of saphenous veins was significantly greater than those of hand veins (1.9 vs 1.4 mm, P < 0.0001) and antecubital veins (1.9 vs 1.6 mm, P = 0.019). Differences in visibility and palpability were observed between different vein types. Hand veins and antecubital veins were rated by the nursing staff as the most likely sites for successful IV placement, whereas saphenous veins were among the least likely (P < 0.0001).
In children younger than 3 years, the saphenous vein is larger than hand veins and is similar in size to antecubital veins, although marginal differences in depth exist. The sonographic findings of the saphenous vein and antecubital vein suggest that either should be considered a superior first choice for IV cannulation in this age group. Knowledge of these differences is important when choosing a site for peripheral IV placement. Future studies should evaluate peripheral IV success rates by vein type with or without ultrasound guidance.
本研究的主要目的是使用床边超声测量3岁以下儿童外周静脉的宽度和深度。次要目的包括评估可能影响静脉（IV）穿刺部位选择的其他静脉和患者特征。对护理人员对外周静脉穿刺部位选择的偏好进行了评估。
纳入60名年龄在0至3岁、前往城市儿科急诊科就诊的儿童。记录超声测量的静脉横径（宽度）以及从静脉顶部到皮肤的距离（深度）。检查时，将静脉分类为可见、可触及、仅通过超声可检测到或无法检测到。16名护士对不同外周静脉进行静脉穿刺成功可能性的评分。
隐静脉的平均宽度显著大于手部静脉（2.8对1.8毫米，P<0.0001）。将隐静脉与肘前静脉比较时，平均宽度无显著差异（2.8对2.8毫米）。隐静脉的平均深度显著大于手部静脉（1.9对1.4毫米，P<0.0001）和肘前静脉（1.9对1.6毫米，P=0.019）。不同类型静脉在可见性和可触知性方面存在差异。手部静脉和肘前静脉被护理人员评为静脉穿刺最有可能成功的部位，而隐静脉则是最不可能成功的部位之一（P<0.0001）。
在3岁以下儿童中，隐静脉比手部静脉大，大小与肘前静脉相似，尽管深度存在微小差异。隐静脉和肘前静脉的超声检查结果表明，在该年龄组中，两者都应被视为静脉穿刺的首选部位。了解这些差异对于选择外周静脉穿刺部位很重要。未来的研究应评估在有或无超声引导下不同类型静脉的外周静脉穿刺成功率。
