Intravenous Access in Obese Children Should Be Tried First in the Wrist

A new study recommends that in obese children undergoing surgery with a body mass index (BMI) higher than 29, the first peripheral intravenous access (PIV) placement attempt should be on the volar surface of the wrist.

Researchers at the University of Michigan (Ann Arbor, MI, USA) prospectively collected data on 103 children aged 2-18 years undergoing elective noncardiac surgery. A trained research assistant was present for PIV placement in all patients and noted age, gender, ethnicity, weight, height, and BMI. The researchers also collected data on PIV insertion site, number of attempts, number of operators, and the number of cannula used. The main outcome variable was success or failure of PIV placement on the first attempt. Sample size calculation indicated a need for a minimum of 40 obese and 40 control patients.

The results of the study were based on a comparison of 56 lean and 47 obese pediatric patients. PIV cannulation was achieved on the first attempt in 55.2%, while 39.6% of patients had to undergo two or three attempts before successful cannulation. The researchers found that obese children were more likely to have failed attempt at first cannulation than lean controls; similarly, obese children were more likely to require two or more attempts at cannulation than lean children were. The study was published in the February 20, 2010, issue of Pediatric Anaesthesia.

"Obese patients are more problematic with peripheral intravenous placement and, if we can prospectively identify children that are going to require more than one attempt, the first attempted site might be better on the volar surface of the wrist than the dorsum of the hand,” concluded lead author Olubukola Nafiu, M.D., and colleagues of the department of anesthesiology. "Although insertion of a catheter on the volar surface of the wrist can be more painful, since these children were undergoing anesthesia before the intravenous catheter placement, this needn't to be a concern.”

The proportion of hospital patients classified as obese has risen dramatically in recent decades, and it is therefore very important to identify the impact of this shift on the efficacy of clinical procedures, and to amend practice where necessary.

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