I have some unpublished data looking at factors associated with
intravenous cannulation failure.
This was based on a prospective quality assurance project of more than
There are plenty of factors outside our control such as younger age of
child, experience of cannulator.
A 22 gauge cannula vs 24, position of child (comfort position increase
success) and nurse presence were associated with success in univariate
In a multivariate analysis of 2,068 children vein visibility was the
only clinically and statistically significant factor.
Data was presented at Royal Australasian College of Physicians
Conference in Adelaide 2008 by colleague Dr Gunasekera.
A systematic review of parental presence found no significant effect
on procedure outcome (Piira Child: Care, Health & Development, 31, 2,
I think position is very important but hard to study in a controlled
Likewise I advocate "bevel-up", approach angle according to the bevel
cut (bevel cut orthogonal to skin reduces area for nociception).
I think reducing pain and movement increases success.
Topical anaesthetic was shown in a randomised placebo controlled trial
(not many placebo controlled trials) to increase success. (Taddio CMJ
Paediatrics published a supplement looking at needle related pain
I would be interested in other people "tricks of the trade"
Dr David Herd BSc MBChB FRACP
Paediatric Emergency Medicine Specialist
Mater Children's Hospital (from April)
South Brisbane, Queensland
Preferred email: [log in to unmask]
Voicemail: +617 3041 0276
Facsimilie: +617 3041 0288
On 2/03/2009, at 9:34 AM, Robert Waddell II wrote:
> Good afternoon everyone. I need some help!! I've been asked to
> present several pediatric topics at a rural conference of EMT's and
> Paramedics. They have now asked if I could include a lecture on
> "tricks of the trade" of pediatric vascular access. I have a some
> points /suggestions / tricks, but I'm not sure enough for a 60
> minute lecture. If any one has pointers, suggestions, or tricks
> that work for them, please let me know. Thanks in advance for the
> Take care,
> Bob Waddell II
> [log in to unmask]
> 307 920 2020
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> the message: info PED-EM-L
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