Vascular access in children

Abstract

Securing stable vascular access is an important clinical skill for the anaesthesiologist. Sick children, complex surgeries, chronic illnesses, multiple hospitalisations, and prolonged treatments can make vascular access challenging. A search was done in the English language literature using the keywords “paediatric,” “vascular access,” “venous access,” and “techniques” or “complications” in Pubmed, Embase, and Google scholar databases. Articles were screened and appropriate content was included. Intraosseous access is a lifesaving technique that can be performed even in hypovolaemic patients rapidly. Transillumination and near-infrared light improve visualisation of superficial veins in difficult access. Ultrasonography has become the standard of care in selecting the vessel, size of catheter, guide placement, and prevent complications. Fluoroscopy is used during insertion of long-term vascular access devices. This article reviews the various routes of access, their indications, most appropriate site, securing techniques, advantages, disadvantages, and complications associated with vascular access in children.

A review of peripherally inserted central catheters and various types of vascular access in very small children and pediatric patients and their potential complications

“…As shown in Table 4 , various methods of vascular access among children, their advantages and disadvantages, as well as the catheter sizes, are available. Additionally, the most appropriate sites for PICC insertion which provide suitable vascular access among children are shown in Figure 2 [ 65 ].…”

“… The location of the most common vascular access sites for peripheral venous catheter (light blue) central venous catheter (dark blue), arterial access (red) and intraosseous infusion (green). Derived in accordance with Vibhavari et al [ 65 ]. …”

“…Because veins of the lower extremity may cause immobilization of the child, these should not be selected as insertion sites. On the other hand, during the process of accessing antecubital fossa veins, extra care should be taken to avoid inadvertent arterial cannulation [ 65 ]. If unexpected intraoperative hemorrhage happens, the superficial external jugular vein could be selected as an alternative choice.…”

Clinical Perspectives on the Use of Different Peripheral Intravenous Catheters with the Implementation of Volume-based Procurement in China

“…Special considerations should be taken for pediatric patients who are more vulnerable to complications owing to defective products. For example, neonates have fragile venous access, and therefore, multiple insertions can deplete their venous access points [37][38][39]. In this way, it is suggested that pediatric departments should be granted with more flexibility in PIVC purchasing.…”

Positioning of Vascular Access in Pediatric Patients: An Observational Study Focusing on Adherence to Current Guidelines

“…The correct criteria for appropriate peripheral VAD are short-term preventive use (less than five days) and administration of nonirritant infusion therapies [7]; inadvertent administration of irritant or vesicant substances into a peripheral vein can result in tissuedamaging necrosis, requiring surgical intervention to treat [8]. The condition of difficult intravenous access (DIVA) is widespread among both adults and children [9] and is defined as a clinical situation where multiple attempts or special interventions are required to obtain and maintain peripheral venous access [10,11]. A systematic review suggested that the DIVA score should be implemented in pediatric settings to prospectively identify children at risk for difficult vascular access [12].…”