• Pediatric emergency care · Nov 2005

    Randomized Controlled Trial

    Pediatric intravenous insertion in the emergency department: bevel up or bevel down?

    • Karen J L Black, Martin V Pusic, Debbie Harmidy, and David McGillivray.
    • Department of Emergency Medicine and Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada. blackkjl@dal.ca
    • Pediatr Emerg Care. 2005 Nov 1; 21 (11): 707-11.

    ObjectiveIntravenous catheters are usually inserted with the bevel facing up. Bevel down may be superior in small and/or dehydrated children. We seek to determine whether there is a difference in the success rate of intravenous insertion using these 2 methods.MethodsWe recruited children requiring an intravenous catheter in the emergency department where there was time to obtain consent. Patients were randomized to have the first attempt bevel up or bevel down. If the first attempt was unsuccessful, the alternate technique was used on second attempt. Attempts beyond 2 were not tracked.ResultsWe recruited 428 patients. Data are available from 396 (201 bevel-up and 195 bevel-down techniques). At least 63 different nurses participated. The nurses participated in the study a median number of 2 times (maximum, 36). Four nurses used the bevel-down technique more than 10 times. The success rate on first attempt was 75.6% (95% confidence interval [CI], 69.8-81.4) for bevel up and 60% (95% CI, 53.2-66.8) for bevel down. The success rate on second attempt was 56.8% (95% CI, 45.3-68.2) for bevel up and 42.9% (95% CI, 30.3-55.5) for bevel down. In the subgroup of infants weighing less than 5 kg, there was no difference between the 2 techniques on the first attempt, with bevel up having a success of 33% (95% CI, 8.4-57.6) and bevel down 30% (95% CI, 4.1-55.9).ConclusionsThe bevel-up technique performed superior to bevel-down technique in this study. The bevel-down technique might be useful in small infants.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…

What will the 'Medical Journal of You' look like?

Start your free 21 day trial now.

We guarantee your privacy. Your email address will not be shared.