Investigation of Needle Bevel Face Up and Down Orientation on Pediatric Intravenous Access

Intravenous (IV) access is a common medical procedure in pediatrics. During pediatric IV insertion, a small size needle (22-24 gauge, 0.71-0.56 mm OD) with lancet tip is usually used to pierce into the vessel of the pediatric patient [1-3]. Because the veins of children are very thin, IV insertion is usually difficult. If the patient is very young or with other medical complex conditions, for example, high body mass index (BMI), the needle insertion is more difficult and time consuming [4-10]. Clinical observations showed that multiple insertions are usually required for successful IV access [11]. Additional needle passes increase the time as well as pain and other problems of children. The pain and fear of the needle procedure also has a long term negative effect on pediatric patients, who may have a lifelong fear of needles [12-14]. There are several ways to increase the success rate in pediatric IV access, such as developing novel needle design and insertion tool [15, 16], training for pediatric residents and nurses to improve their skills and techniques [17-20], using ultrasound or infrared light guiding equipment to assist insertion procedure [21-24]. Among these methods, improving the needle insertion technique is an effective, economic and practical approach to increase the success rate and reduce the pain of pediatric patients. Needle bevel face orientation is an important but often overlooked factor to be considered in needle insertion techniques [19]. There are two accepted insertion techniques according to bevel face orientation: bevel up and bevel down. Figure 1 shows the schematic of these two insertion techniques. The goal of IV access is to connect the inside of needle tube to the lumen of the vessel without causing the needle tip over-penetrates the posterior wall of the vessel wall. In bevel down insertion orientation, the needle whole bevel face of needle tip has a better orientation to access inside the vessel lumen and result for a successful insertion. In comparison, bevel up insertion, some part of the needle tip is still prone to over-penetrate outside the vessel and may be more likely to results a failure needle IV insertion access. However, bevel down is less popular due to the lack of training and difficulty to visually unable to see the needle bevel face and tip at the penetration point on the skin. In theory, compared to the bevel up Investigation of Needle Bevel Face Up and Down Orientation on Pediatric Intravenous Access