Ultrasound-Guided PIVC Insertion: A Superior Approach for Pediatric Patients

Peripheral intravenous catheter (PIVC) insertion is often challenging in children, leading to multiple attempts, distress, and delayed care. The EPIC Superiority Randomized Clinical Trial investigated whether ultrasound guidance improves first-time PIVC success compared with standard palpation and visualization techniques in hospitalized children.

Study Overview
This open-label, randomized trial was conducted at an Australian quaternary pediatric hospital between July 2021 and December 2022. The study enrolled 164 children (aged 0-18 years) needing PIVC insertion, stratified by risk of difficult access (low, medium, or high). Patients were randomly assigned to ultrasound-guided or standard PIVC insertion, with outcomes analyzed by intention to treat.

Key Findings
1. First-time success: Ultrasound-guided insertion achieved significantly higher first-attempt success (85.7%) compared to standard technique (32.5%).

2. The benefit was consistent across risk groups:

• Low risk: +30.8% success difference
• Medium risk: +56.2% success difference
• High risk: +69.6% success difference
• Ultrasound use led to fewer insertion attempts and higher patient and parent satisfaction.

3. Although immediate healthcare costs were slightly higher (A$9.33 more per person), the improved success rates suggest long-term value.

Conclusion
The EPIC trial provides robust evidence that ultrasound-guided PIVC insertion significantly improves first-attempt success in pediatric patients, regardless of their risk of difficult access. These results support the widespread adoption of ultrasound guidance as standard practice in pediatric vascular access.

Read more: https://jamanetwork.com/journals/jamapediatrics/article-abstract/2829639 

Authors: Tricia M. Kleidon, Jessica A. Schults, Ruth H. Royle, Robert S. Ware, Victoria Gibson, Derek J. Roebuck, Deborah Peirce, Ruth Royle, Robert S. Ware, Joshua Byrnes, Elizabeth Andresen, Paula Cattanach, Anna Dean, Colleen Pitt, Malanda Ramstedt, Craig A. McBride, Stephanie Hall, Claire M. Rickard, Amanda J. Ullman