FV, FA and IJV depth and diameter correlated with weight, size, age and body surface area in the studied pediatric patients. Correlation was better for femoral than for jugular vessels. Depth could be estimated from patients' weight and size, while diameter could be estimated from the size. Such estimations may facilitate the choice of vessels to be cannulated, length and diameter of cannulation needles and the diameter of catheters to be used in pediatric patients.

SUMMARYCritically ill patients with brain injury associated with organ dysfunction among which include pulmonary involvement as a determinant of morbidity and mortality. The aim of this paper is to review the major complications associated with brain injury in patients with brain injury, etiology, clinical, prevention and treatment.

In pediatric patients, major vessels can be located and their depth and diameter measured by vascular ultrasound. In younger patients, jugular and femoral vessels had similar depth values; in older ones, they had similar diameters. Ultrasound measurements in pediatric patients could facilitate the choice of the vessel to be cannulated, the catheter diameter, and the length of the needle to be used. Vascular canalization of IJV may be recommended as the first choice because of its low depth and large diameter.

Simulation has been defined as the representation of something as real. It is necessary for performing the ultrasound-guided vascular cannulation technique correctly. The use of training models for diagnostic or therapeutic procedures: improves the quality of care for patients; decreases stress level that it can produce the realization of a new technique directly on the patient and; can be used as many times as the model is reproduced, also serving as a method for the resolution of some problems that may appear related to the in vivo technique. The evidence shows that simulation plays an important role in the acquisition of skills to perform invasive procedures. The use of ultrasound in vascular accesses whether peripheral or central, arterial, or venous, improves the success rate in the canalization and reduce the complications derived from the technique in certain critical situations (coagulopathy, thrombocytopenia, obesity, etc.) specially in pediatric patients given the variability of depth and diameter of its vessels with respect to the adult population. To facilitate learning in the technique of echoguided puncture, a training model is presented that is easily reproducible, economical and with a high fidelity in relation to the punctures performed on the patient.

We report the case of two-year-old girl with hypovolemic shock caused by bleeding from an abdominal cystic lymphangioma. The whole blood was contained within a large omental bag that could be completely removed. There were no associated anomalies. The child progressed satisfactorily.

No abstract

Introduction. Central vascular cannulation in children is a highly complex technique and poses many difficulties. Vascular ultrasound can make this procedure easier. Objective. To describe the characteristics of ultrasound-guided vascular cannulation in critically-ill pediatric patients. Population and methods. Outcome measures prospectively recorded were vessels most frequently cannulated, their localization, the measurement of their diameter/depth, the success rate and complications developed, among others. Results. One hundred and twenty four vascular punctures were performed in 86 pediatric patients. Vascular accesses were the femoral vein (39.7%), followed by the femoral artery (27.2%) and the internal jugular vein (14.7%). Femoral vessels were localized at a depth of 0.75 ± 0.25 mm, with a mean diameter of 0.31 ± 0.16 mm. The depth of jugular vein vessels was smaller (0.64 ± 0.24 mm) and their overall diameter, larger (0.44 ± 0.19 mm). The mean number of attempts in ultrasound-guided cannulations was 2.2 ± 1.3. The success rate was 79% and was associated to a larger vessel diameter (0.39 ± 0.20 mm vs. 0.28 ± 0.13 mm, p= 0.01) and a lower number of attempts (1.90 ± 1.16 vs. 3.45 ± 1.77, p= 0.001). Complications were accidental puncture of another vessel (5.3%) and hematoma formation during puncture (2.3%). Conclusions. In the pediatric patients studied, ultrasound-guided vascular cannulation allowed vessel visualization and measurement of their depth and diameter; the success rate was high and it was associated to a low complication rate.

No abstract