Positive effects of ultrasound-guided peripheral IV insertion on pediatric sickle cell anemia/thalassemia patients receiving automated red cell exchange procedures or chronic transfusion therapy.

Background: Peripheral vascular access and venipuncture are major causes of distress and anxiety for children and their parents. This is especially difficult for patients with hemoglobinopathies (thalassemia major and sickle cell disease) who require chronic blood transfusions. These patients require peripheral venous access for regular blood transfusions and (in the case of sickle cell disease) for automated red cell exchange procedures. Peripheral intravenous (PIV) catheters are much preferred to central venous lines as they carry far fewer risks. However, when patients experience multiple unsuccessful attempts to initiate a PIV, it can be traumatizing and cause anxiety for future visits. Establishing therapeutic trust and ensuring a smooth experience are of paramount importance for these chronic patients who require regular blood transfusions.

Aim: The purpose of this study was to determine whether ultrasound-guided PIV insertion decreases PIV-associated pain and anxiety, and whether the number of attempts and amount of time spent accessing PIVs in children with difficult peripheral intravenous (DPIV) access is reduced.

Materials And Methods: This was a pilot study with both retrospective and prospective components. Hemoglobinopathies are relatively rare in our population and our study cohort was small (N = 18).

Results: We identified four DPIV access patients. We recorded each time these patients had a PIV inserted as an encounter.

Discussion/conclusion: We found that while there was a small amount of time gained by using ultrasound-guided PIV insertion, patient and parent satisfaction was significantly improved.