Related Experiment Video
Updated: Jul 18, 2025
In Vivo Real-Time Study of Drug Effects on Carotid Blood Flow in the Ovine Fetus
Published on: April 28, 2023
Establishing Carotid Seldinger as Routine Access in Infants; Planning, Performance, and Follow-Up Protocols
Ernesto Mejia1, Daniel McLennan2,3, Jenny Zablah1
1Department of Pediatric Cardiology, University of Colorado, Children's Hospital Colorado, The Heart Center, 13123 E 16th Ave, B100, Aurora, CO, 80045, USA.
Insights
Implementing a systematic approach for percutaneous carotid access (PCA) in infants significantly improved procedural efficiency and safety. This protocolized method, including imaging follow-up, resulted in no major complications and preserved vessel patency.
Area of Science:
- Pediatric Cardiology
- Interventional Radiology
- Vascular Access
Background:
- Percutaneous carotid access (PCA) in infants has been described in limited studies.
- A need exists to evaluate systematic approaches for optimizing PCA outcomes in neonates and infants.
Purpose of the Study:
- To compare outcomes after implementing a systematic approach to PCA in infants.
- To assess the safety and efficacy of a protocolized PCA technique with imaging follow-up.
Main Methods:
- Retrospective case-control study of 82 PCAs in 74 infants (median age 14 days) from 2013-2022.
- Implementation of a protocol in 2020 included head-to-toe orientation, 4-hour post-procedure monitoring, and routine ultrasound.
- Vascular access was performed using a modified 21g butterfly needle for various cardiac interventions.
Main Results:
- The protocolized approach significantly improved time to access without major complications.
- Two access-related complications occurred pre-protocol (vascular repair, thrombus).
- Increased sheath time post-protocol correlated with case complexity but not with vessel injury or thrombus; no neurological insults were reported.
Conclusions:
- Percutaneous carotid access is a safe and effective technique in infants, irrespective of weight or sheath size.
- A protocolized strategy for PCA planning, recovery, and follow-up is recommended for safe practice and complication management.
Abstract:
Percutaneous carotid access (PCA) in infants has been reported in small multicenter cohorts, case reports and wider studies over the last 20 years. Compare outcomes after implementation of a systematic approach to PCA in a single center including an imaging follow-up protocol. Retrospective case-control study of PCA at Children's Hospital Colorado was performed from January 2013 to December 2022. Seventy-four patients underwent 82 PCAs for cardiac catheterization. The median age (range) was 14 days (1-359), and weight was 3.25-kg (1.9-7.9). Median sheath size was 4-Fr (3.3-6). Seventy-seven interventions performed included PDA stenting, aortic valvoplasty, BTT shunt stenting, and coarctation stenting. Vascular access was performed using a modified 21 g butterfly needle. A protocolized approach was implemented in 2020 reversing the patient head-to-toe orientation on the catheterization table, maintaining intubation and sedation for 4-h during recovery and routine use of a specific vascular ultrasound protocol. Following these changes, time to access significantly improved with no major complications. Before 2020, two access related complications occurred. One requiring surgical vascular repair and one occlusive thrombus. A significant increase in sheath time in post-era was associated with increased case complexity. Longer sheath times were not associated with increased risk of vessel injury or thrombus. No neurological insults were reported. Our experience confirms that PCA is safe and achievable with preserved vessel patency regardless of patient weight or sheath size. A protocolized planning, recovery, and follow-up regimen is recommended to establish safe practice and identify and treat complications as necessary.
