This retrospective medical record review investigated peripheral intravenous (IV) access success rates by paramedics in patients aged ≤18 years in Minnesota and Western Wisconsin from 1 January 2003 until 31 May 2011. From 2003 onwards, paramedics recorded IV attempts via an electronic medical record system, and this was used to export data for analysis. Prior to this, written records were used to verify success rates.
Statistical analysis was performed using chi-squared testing to investigate the relationship of variables such as age and gender to IV success rates. Further evaluation of the relationship of age to IV success rates was undertaken using univariate logistic regression.
During the study period, there were 261 008 ambulance responses. At least one attempt at IV access was made on 4 188 patients aged ≤18 years, representing 2% of the total response volume.
The mean age of study patients was 14.1 years and 53.4% were male. Male patients were marginally but statistically significantly more likely to have successful IV placement than females (89% versus 87%, p=0.046). The overall success rate for paediatric IV access was 88.3% (n=3699).
In the majority of patients, only one attempt was made at IV access (89.2%, n=3735). Almost one in ten patients had two attempts (9.9%), with the remainder undergoing between three and six attempts.
Regression analysis demonstrated that age was significantly associated with IV success rates, with each one year increase in age associated with an 11% increase in the odds of successful IV placement (OR 1.11, 95% CI 1.09–1.12, p<0.001). The mean age for patients with successful IV placement was 14.5 years, compared with a mean age of 11.3 years for patients in whom the procedure was unsuccessful. Success rates were lowest in infants at 63.2% (n=60/95), and highest in patients aged 18 years at 92.4% (n=774/838).
The authors conclude that IV success rates decline significantly with age and that opportunities for the 241 healthcare providers (employed by the agency used in the study) to perform the procedure on younger patients are limited. It is suggested that in life-threatening emergencies, it may be appropriate to recommend the use of intraosseous devices as the first line method of obtaining vascular access in younger children given the low IV success rates identified in this study.
‘Regression analysis demonstrated that age was significantly associated with IV success rates’
Limitations associated with this study include self-reporting by paramedics of the number of attempts at IV access and overall success rates, which were not verified via other sources such as hospital records. No attempt was made to evaluate the indications for IV access, which might have provided insight as to the reasons for lower success rates in younger patients.