Hinterstein Samantha, Ehrhardt Harald, Zimmer Klaus-Peter, Windhorst Anita Cornelia, Kappesser Judith, Hermann Christiane, Schuler Rahel, Waitz Markus
Department of General Pediatrics and Neonatology, Center for Pediatrics and Youth Medicine, Justus-Liebig-University of Giessen, Giessen, Germany.
Institute of Medical Informatics, Justus-Liebig-University of Giessen, Giessen, Germany.
Neonatology. 2024;121(6):733-741. doi: 10.1159/000538880. Epub 2024 May 16.
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.
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.
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.
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.
建立外周静脉通路对儿科住院医师来说具有挑战性，对新生儿而言则是一种痛苦的操作。我们评估了在儿科住院医师进行外周静脉导管插入术期间，一种红色发光二极管透照仪的有效性。
患者按当前体重（≤1500克、>1500克）分层，并随机分为透照组或对照组。前三次尝试由儿科住院医师进行，随后由新生儿科医生进行三次尝试。主要结局是首次尝试成功。次要比较包括成功插入的时间以及住院医师和新生儿科医生的总体成功率。
共分析了559例操作。在体重≤1500克的分层中，使用透照仪时住院医师首次尝试的成功率为44/93（47%），未使用透照仪时为44/90（49%）（p = 0.88）；在体重>1500克的分层中，使用透照仪时为103/188（55%），未使用透照仪时为64/188（34%）（p < 0.001）。在体重>1500克的分层中，透照组住院医师的总体成功率为86%，对照组为73%（p = 0.003），但在体重≤1500克的分层中无差异（78/93 [84%] 对72/90 [80%]，p = 0.57）。当住院医师的经验水平超过6个月时，没有效果。在两个体重分层中，新生儿科医生的总体成功率和成功插管时间均无显著差异。
透照可提高儿科住院医师对体重>1500克新生儿进行外周静脉插管的首次尝试成功率，而在体重≤1500克的婴儿中未发现益处。
