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Vascular access in children
Vibhavari M Naik1, S Shyam Prasad Mantha1, Basanth Kumar Rayani1
1Department of Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India.
Insights
Securing pediatric vascular access is crucial for anesthesiologists. Advanced techniques like ultrasonography and intraosseous access improve success rates in challenging cases.
Area of Science:
- Pediatric Anesthesiology
- Vascular Access Techniques
Background:
- Vascular access is a critical skill for anesthesiologists, often challenging in pediatric patients due to various medical conditions.
- Difficult vascular access in children requires specialized techniques and tools for successful outcomes.
Purpose of the Study:
- To review various pediatric vascular access routes, techniques, and complications.
- To provide guidance on indications, site selection, and securing methods for pediatric vascular access.
Main Methods:
- Comprehensive literature search in PubMed, Embase, and Google Scholar using keywords like 'pediatric,' 'vascular access,' 'venous access,' and 'techniques' or 'complications.'
- Screening of English language articles to include relevant content on pediatric vascular access.
Main Results:
- Intraosseous access is a rapid, life-saving technique, even in hypovolemic pediatric patients.
- Transillumination, near-infrared light, and ultrasonography enhance vein visualization and guide catheter placement, reducing complications.
- Fluoroscopy is valuable for long-term vascular access device insertion.
Conclusions:
- Ultrasonography is the standard of care for pediatric vascular access, improving vessel selection and complication prevention.
- Various techniques, including intraosseous, transillumination, and ultrasonography, offer solutions for challenging pediatric vascular access.
- This review synthesizes information on pediatric vascular access routes, techniques, and complications for clinical application.
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.
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