Ultrasound guidance versus transillumination for peripheral intravenous cannulation in pediatric patients with difficult venous access

Objective
Venous access can be technically difficult in pediatric patients because of the small size and impalpability of their veins. The aim of this prospective randomized study was to compare the use of ultrasound (US) guidance and transillumination as aids to facilitate peripheral intravenous cannulation in pediatric patients with difficult venous access.
Patients and methods
We included 80 children, less than 6 years of age, undergoing elective surgery, and having difficult venous access as predicted by a Difficult Intravenous Access score of at least 4. The patients were randomized to either US guidance (the US group, = 40) or transillumination using the Veinlite EMS (the Veinlite group, = 40). Cannulation was performed after inhalation induction of anesthesia. The primary outcome measure was the first-attempt success rate of cannulation. The secondary outcome measures were the overall success rate of cannulation, number of attempts, and time required to achieve successful cannulation.
Results
The first-attempt success rate was significantly higher in the US group (82.5%) compared with the Veinlite group (57.5%, < 0.05). Both groups showed a high overall success rate (92.5% in the US group and 80% in the Veinlite group, = 0.19). The time to achieve successful cannulation was significantly shorter in the US group (67.1 ± 19.3 s) than in the Veinlite group (94.1 ± 49.9 s, < 0.01). The number of attempts required was not significantly different between the two groups.
Conclusion
Both US guidance and transillumination facilitate peripheral intravenous cannulation in pediatric patients with difficult venous access, resulting in a high overall success rate of cannulation. US guidance is superior as it results in a higher first-attempt success rate with less time required to achieve successful cannulation compared with transillumination.