The passive leg raise (PLR) results in fewer attempts at intravenous (IV) access than no leg raise in paediatric patients, according to a study presented here at the 2018 Annual Meeting of the Canadian Anesthesiologists Society (CAS).
“Obtaining IV access can be a challenge in the paediatric setting,” explained Patrick Valcke, MD, University of Saskatchewan, Saskatoon, Saskatchewan, on June 18. “We have limited options at our disposal for establishing IV access.”
PLR represents a possible solution to establishing IV access because it redistributes lower-extremity blood volume to the central circulation and is recognised as widening central venous diameter.
“We thought this might be a novel way to improve our success rates,” said Dr. Valcke. “We have used it in clinical practice and thought it might be way to increase the diameter of peripheral veins in addition to central veins.”
A total of 87 children who were undergoing inhalational induction of anaesthesia for dental procedures were randomised to a PLR approach (n = 43) or no leg raise (n = 44). Antecubital vein diameter was first measured by ultrasound. Diameter was reassessed, and peripheral IV access was attempted.
The investigators noted changes in peripheral vein diameter, time to IV cannulation, and the number of IV placement attempts.
Surprisingly, vein diameter decreased by 0.06 mm in the PLR group and increased by 0.1mm in the control group (P = .31). The median time to cannulation favoured the PLR group (22.3 vs 34.9 s; P = .16). Patients in the PLR group did not need as many attempts at IV placement; 39 patients in the PLR group required only 1 attempt versus 31 patients in the control group (P = .017).
“What we saw in terms of the difference in vein diameter was a bit perplexing,” said Dr. Valcke. “We expected to see an increase in vein diameter in those that had PLR.”
Still, use of PLR proved effective because it required fewer IV attempts in a statistically significant way.
One of the limitations of the study was that it included different operators, including nurses, dental surgeons, and anaesthesiologists, performing the attempts at IV access.
“It would be beneficial to standardise it and have all IVs attempted by anaesthesiologists,” concluded Dr. Valcke.
Future research would involve a larger sample size and include various procedures in paediatrics, such as tonsillectomy or hernia repair, said Dr. Valcke.