Ultrasound-guided femoral vein catheterization in neonates with cardiac disease*

Alten, Jeffrey A.; Borasino, Santiago; Gurley, William Q.; Law, Mark A.; Toms, Rune; Dabal, Robert J.

doi:10.1097/pcc.0b013e318250af0c

Cited by 31 publications

(43 citation statements)

References 29 publications

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“…3,16,17 Similar with our results Alten et al showed that there were fewer complications of venous thrombosis in patients where ultrasound was used compared with the standard landmark technique, but the results were not statistically significant. 18 No potential mechanical complications (arterial puncture, malposition, arrhythmia and pneumothorax) associated with catheter insertion occurred in our study. Findings from the PICUs in our country, catheterization without the guidance of ultrasound has a mechanical complication rate of 3.3-9.7% while the rates are within the range of 0.3% and 25.5% in the literature.…”

Section: Resultsmentioning

confidence: 59%

Use of ultrasound for central venous catheterization in pediatric intensive care unit; a single center experience

Tolunay¹,

Okuyan²,

Çelik³

et al. 2015

Turk J Ped Em Int Care Med

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Methodsby an interventional radiology expert. Subclavian vein was not preferred since it complicated the insertion of the catheter into the clavicle under ultrasound guidance. Adequate anesthesia was achieved prior to the procedure (1 μgr/kg fentanyl); sedation was ensured using midazolam (0,1 mg/kg) or ketamine (1-2 mg/kg). During the procedure, the patients were followed under continuous monitoring of the cardiac rate and rhythm, the respiratory rate and oxygen saturation. Except emergency situations, patients with pre-existing thrombocytopenia and abnormal coagulation test results were given supportive treatment and the catheter was inserted in these patients after the test results returned to normal. Central venous catheters were inserted by the pediatricians employed at the intensive care unit or interventional radiology expert at the pediatric intensive care unit. Double-lumen 4-Fr, triple-lumen 5-Fr, triple-lumen 7-Fr polyurethane transient catheters were used for patients with a body weight below 5 kg, between 5 and 20 kg and above 20 kg, respectively (Guangdong Baihe Medical Technology, China).For the purpose to recognize artery and vein; 1-the anatomic positions of internal jugular and femoral veins relative to arteries (internal jugular vein lies on the lateral side of the common carotid artery, femoral vein lies on the medial side of the femoral artery) (figure 1,2), 2-the compressibility of the internal jugular and femoral veins relative to arteries (figure 1,2), 3-in case of difficulty of discriminating the veins and arteries, the shape of the flow was investigated using Doppler mode of ultrasound (Figure 3). While transverse access was mostly used due to the size of the ultrasound probe, CVC was conducted using longitudinal access with real-time images in older patients (figure 4).Hand hygiene and aseptic conditions were ensured to manage infections. The site of administration was sterilized using 10% povidone iodine. A sterile ultrasound gel (Aquatouch Jelly, Turkey) and sterile transducer cover (Medbar Cardboard Camera Cover, Turkey) was used. While inserting the catheter, a "laptop style" ultrasound device and a straight linear probe (7.5 MHz) was used (Mindray-M5 Ultrasound System, China). The catheters were inserted using the Seldinger technique. The location of the catheter was assessed by posterior-anterior chest radiograph for the internal jugular catheters and the localization was deemed appropriate if the tip of the catheter was in the space between the distal part of vena cava superior and the entrance of the right atrium. Dressings were applied once every two days. Patients exhibiting the same microorganism growth in the catheter culture and the peripheral blood culture with accompanying the sepsis clinical findings and signs were diagnosed as central line-associated bloodstream infection while those with erythema, indurations and tenderness within 2 cm distance around the catheter exit were diagnosed with catheter exit-site infection 9 .

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Section: Resultsmentioning

confidence: 59%

Use of ultrasound for central venous catheterization in pediatric intensive care unit; a single center experience

Tolunay¹,

Okuyan²,

Çelik³

et al. 2015

Turk J Ped Em Int Care Med

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“…We and others have previously shown challenging access is more readily obtained using real-time US guidance with long-axis approach via linear transducer. 5,6 We were able to achieve ECMO flows of 600 ml/min (60 ml/ kg/min), improving oxygenation and lactic acidosis. Attempts at higher flows were associated with increased negative return line pressures, likely related to kinking "memory" in cannula caused when cannula was rotated 180° immediately after insertion process (cannula inside body did not rotate when external ports were rotated).…”

Section: Discussionmentioning

confidence: 98%

Transhepatic Cannulation for Venovenous Extracorporeal Membrane Oxygenation

Rhodes

Sasser²,

McMahon³

et al. 2015

ASAIO Journal

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Limited vascular access because of vessel injury or thrombosis may complicate care of children with congenital heart disease. Although transhepatic venous access for cardiac catheterization and central venous catheter placement has been used in children, its use for extracorporeal membrane oxygenation (ECMO) has not been described. We report successful use of transhepatic cannulation for venovenous ECMO to support a 15 month-old child with bidirectional Glenn anatomy and intractable hypoxemia.

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“…42 Alten et al reported a trend towards less DVT with ultrasound-guided femoral vein catheterization. 43 …”

Section: Prevention Of Venous Thromboembolismmentioning

confidence: 99%

Venous thromboembolism in critically ill children

Polikoff

Faustino

2014

Current Opinion in Pediatrics

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Purpose of review To review the current literature on venous thromboembolism in critically ill children Recent findings There is increasing concern for venous thromboembolism and its complications in critically ill children. Critically ill children are at increased risk of thromboembolism because of the treatment that they are receiving and their underlying condition. A complex relationship exists between thrombosis and infection. A thrombus is a nidus for infection while infection increases the risk of thrombosis. Pediatric-specific guidelines for the prevention and treatment of thromboembolism are lacking. Current guidelines are based on data from adults. Novel anticoagulants are now available for use in adults. Studies are ongoing to determine their safety in children. Risk assessment tools have recently been developed to determine the risk of thromboembolism in critically ill children. Certain molecules are associated with thromboembolism in adults. Summary Pediatric critical care practitioners should be cognizant of the importance of venous thromboembolism in critically ill children to allow for early identification and treatment. Adequately powered clinical trials are critically needed to generate evidence that will guide the treatment and prevention of thromboembolism in critically ill children. Risk assessment tools that incorporate biomarkers may improve our ability to predict the occurrence of thromboembolism in critically ill children.

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Ultrasound-guided femoral vein catheterization in neonates with cardiac disease*

Abstract: This novel long-axis real-time ultrasound technique facilitates placement of femoral vein central venous line in critically ill neonates with cardiac disease at a higher rate of success with fewer attempts and lower occurrence of complications when compared with the landmark technique.

Cited by 31 publications

References 29 publications

Use of ultrasound for central venous catheterization in pediatric intensive care unit; a single center experience

Use of ultrasound for central venous catheterization in pediatric intensive care unit; a single center experience

Transhepatic Cannulation for Venovenous Extracorporeal Membrane Oxygenation

Venous thromboembolism in critically ill children

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