Skin Transillumination Improves Peripheral Vein Cannulation by Residents in Neonates: A Randomized Controlled Trial

Abstract

<b><i>Introduction:</i></b> Establishing peripheral vein access is challenging for pediatric residents and a painful procedure for neonates. We assessed the efficacy of a red light-emitting diode transilluminator during peripheral vein catheter insertion performed by pediatric residents. <b><i>Methods:</i></b> Patients were stratified by current weight (≤1,500 g, &gt;1,500 g) and randomized to the transillumination or the control group. The first three attempts were performed by pediatric residents, followed by three attempts by a neonatologist. The primary outcome was success at first attempt. Secondary comparisons included time to successful insertion and overall success rates of residents and neonatologists. <b><i>Results:</i></b> A total of 559 procedures were analyzed. The success rate at resident’s first attempt was 44/93 (47%) with transillumination versus 44/90 (49%) without transillumination (<i>p</i> = 0.88) in the strata ≤1,500 g and 103/188 (55%) with transillumination versus 64/188 (34%) without transillumination in the strata &gt;1,500 g (<i>p</i> &lt; 0.001). The overall success rate for residents was 86% in the transillumination versus 73% in the control group in the strata &gt;1,500 g (<i>p</i> = 0.003) but not different in the strata ≤1,500 g (78/93 [84%] vs. 72/90 [80%], <i>p</i> = 0.57). There was no effect when the experience level of residents exceeded 6 months. Neonatologists’ overall success rate and time to successful cannulation did not differ significantly in both weight strata. <b><i>Conclusion:</i></b> Transillumination improves the first-attempt success rate of peripheral vein cannulation performed by pediatric residents in neonates &gt;1,500 g, while no benefit was found in infants ≤1,500 g.