Gaining vascular access in pediatric patients: use of the P.D. access Doppler needle

This article describes our initial experience with the P.D. Access Doppler needle for obtaining vascular access in pediatric patients. Patients were considered for use of the P.D. Access Doppler needle (Escalon Vascular Access, New Berlin, WI) if they had a history of difficult access or body habitus limitations to vascular access. An 18-, a 20-, or a 22-gauge bare needle with an inserted Doppler stylet was utilized. The time from initial subcutaneous entry of the Doppler needle until wire placement into the vessel lumen was recorded. Initial attempts to cannulate were performed with standard Seldinger technique. If attempts with the standard technique were unsuccessful, then P.D. Access was utilized. However, P.D. Access was used primarily in small children for internal jugular vein cannulation or in patients with coarctation who had absent/diminished femoral pulses. P.D. Access cannulation was attempted 39 times (31 patients). Median age is 23 months (range, 1 day to 15 years). Median weight is 10.5 kg (range, 1.7-57 kg). These patients had a mean of two prior cardiac catheterizations and/or surgeries (range, 0-6 procedures). Use of P.D. Access resulted in successful cannulation in 35/39 (90%) attempts. In successful outcomes, the time from initial subcutaneous entry to cannulation is 6.5+/-4.9 min. In unsuccessful outcomes, failure was due to prior hematoma formation, operator inexperience, or prior vessel occlusion. Successful use of P.D. Access shortens the duration of vascular access in difficult pediatric patients. In our cardiac catheterization laboratory, this technique has become the preferred initial entry technique for cannulation of the internal jugular vein in small children. In addition, this technique was particularly useful for femoral artery cannulation in patients with coarctation of the aorta with absent/diminished femoral pulses.