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Ultrasound guided vascular access in pediatric cardiac critical care
Abdulraouf M Z Jijeh1, Ghassan Shaath1, Mohamed S Kabbani1
1Pediatric Cardiac Intensive Care Unit, King Abdulaziz Cardiac Center, Riyadh, Saudi Arabia.
Insights
Ultrasound-guided vascular access in pediatric patients with congenital heart disease is safe and effective. This method achieved high success rates with no complications, improving patient care.
Area of Science:
- Pediatric critical care medicine
- Medical imaging
- Vascular access techniques
Background:
- Pediatric vascular access is challenging, particularly in infants and children with congenital heart disease.
- Developing safer methods for vascular access is crucial for this vulnerable population.
Purpose of the Study:
- To evaluate the safety and efficacy of ultrasound-guided vascular cannulation in pediatric patients.
- To highlight real-world experience with this technique in infants and children with congenital heart disease.
Main Methods:
- Prospective monitoring of vascular access attempts using ultrasound guidance.
- Data collection on patient demographics, procedure details, and complications.
- Analysis of success rates for arterial and venous cannulation.
Main Results:
- High success rates: 93% for arterial and 95% for venous cannulation.
- Efficient procedure: Mean time from puncture to wire insertion was 3.9 minutes.
- No complications reported, even in low-birth-weight infants (<3.5 kg).
Conclusions:
- Ultrasound-guided vascular cannulation is a safe, effective, and efficient method for critically ill pediatric patients.
- The technique demonstrates a high success rate and zero complications in this cohort.
- This approach offers a valuable improvement for vascular access in pediatric congenital heart disease patients.
Introduction:
Safely obtaining vascular access in the pediatric population is challenging. This report highlights our real-world experience in developing a safer approach to obtaining vascular access using ultrasound guidance in children and infants with congenital heart disease.
Methods:
As part of a quality initiative, we prospectively monitored outcomes of all vascular access attempts guided by ultrasound from January 2010 to September 2010. Variables monitored included age, weight, the time from first needle puncture to wire insertion, site of insertion, number of attempts, type of line, and complications.
Results:
There were 77 attempts (15 arterial and 62 venous) to obtain vascular access in 43 patients. The mean age was 15 months (6 days-11 years; median 2.5 months). The mean weight was 7.2 kg (2-46 kg, median 3.8). Success rates were 93% and 95% for arterial and venous cannulation, respectively. Mean time from first needle puncture to wire insertion was 3.9 min (0.5-15 min, median 2 min). Fifty-five (75%) central line cannulations were successful from the first puncture; 17(23%) were successful from the second puncture; and one case (2%) required three punctures. Thirty patients (45%) weighed less than 3.5 kg. This lower body weight did not affect success rate, which was unexpectedly high (96.6%). There were no associated complications.
Conclusion:
Ultrasound guided vascular cannulation in critically ill pediatric patients is safe, effective and efficient. This approach had a high success rate, and was associated with zero complications in our setting.
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