Vascular Access In Infants Research Articles

Standard practice and evolving trends in pediatric intravenous access

Intravenous access, although often considered a basic skill, requires significant training, reinforcement, and problem-solving skills. Similar to other advanced procedures, peripheral intravenous (PIV) access in infants and children is a complex skill that requires adequate preparation, the ability to identify anatomic landmarks for guidance in placement, familiarity with equipment, and the capacity for alternate methods of obtaining venous access to complete the treatment goal. Vascular access in infants and children is a technically difficult skill compounded by the limited timeframes to achieve success.

Vascular access for cardiac catheterization of patients with congenital heart disease

Pediatric cardiac catheterization has progressed over the past 50+ years into a sub-specialty with numerous diagnostic and interventional procedures for the care of children with congenital heart disease. There are increasing numbers of patients who are surviving with complex congenital heart lesions, as well as more therapeutic interventional procedures being performed in the catheterization laboratory. Obtaining vascular access in infants and children with multiple prior catheterizations can pose a significant challenge to the pediatric interventional cardiologist. In the early years of cardiac catheterization, cutdown procedures and direct puncture methods were utilized to perform diagnostic cardiac evaluations. These procedures have fallen out of favor as newer, less invasive methods of vascular access have developed. The cutdown procedures of the arterial and venous vessels have gradually given way to percutaneous procedures for vascular access. We have found that standard percutaneous methods can be augmented with cutdown procedures of the vessels used in catheterization. In addition, numerous unique methods for vascular access have developed. These include carotid, translumbar and transhepatic. With adequate experience, these procedures can be performed safely and effectively when routine vascular access for catheterization is not an option. Vascular access for catheterization is dependent on patient characteristics, operator skills, and the procedure being performed.

Consultation with the specialist. Vascular access.

Achieving vascular access in infants and children is often a challenge for emergency medical technicians, nurses, and physicians. It is a vital intervention in the critically ill or injured child and is necessary for infusing medications and fluids and obtaining blood samples for laboratory analysis. It often takes more than 10 minutes to achieve venous access during pediatric resuscitation. The presence of subcutaneous fat, the small size of peripheral vessels, vasoconstriction, and the behavior of anxious and frightened infants and children often are barriers to successful intravenous line placement. Other factors that may affect success include: 1) the skill of the person performing the procedure, 2) immobilization of the patient and/or extremity, 3) the availability of small over-the-needle catheters, 4) the availability of all materials necessary to secure the line, and 5) the site of catheter placement. Critically ill or injured pediatric patients need rapid vascular access. Health-care providers, therefore, must understand the priorities for obtaining access to a vein. Peripheral venous access is a satisfactory route for infusions, but no more than 1 to 2 minutes should be spent attempting to establish peripheral intravenous access in ill or injured patients. A reasonable approach to vascular access in these patients is as follows: 1) Attempt peripheral access for 1 to 2 minutes

Consultation with the Specialist

Achieving vascular access in infants and children is often a challenge for emergency medical technicians, nurses, and physicians. It is a vital intervention in the critically ill or injured child and is necessary for infusing medications and fluids and obtaining blood samples for laboratory analysis. It often takes more than 10 minutes to achieve venous access during pediatric resuscitation. The presence of subcutaneous fat, the small size of peripheral vessels, vasoconstriction, and the behavior of anxious and frightened infants and children often are barriers to successful intravenous line placement. Other factors that may affect success include: 1) the skill of the person performing the procedure, 2) immobilization of the patient and/or extremity, 3) the availability of small over-the-needle catheters, 4) the availability of all materials necessary to secure the line, and 5) the site of catheter placement. Critically ill or injured pediatric patients need rapid vascular access. Health-care providers, therefore, must understand the priorities for obtaining access to a vein. Peripheral venous access is a satisfactory route for infusions, but no more than 1 to 2 minutes should be spent attempting to establish peripheral intravenous access in ill or injured patients. A reasonable approach to vascular access in these patients is as follows: 1) Attempt peripheral access for 1 to 2 minutes

Angioplasty guidewire for vascular access in infants and neonates

Catheterization and Cardiovascular DiagnosisVolume 31, Issue 3 p. 253-254 Letter To The Editor Angioplasty guidewire for vascular access in infants and neonates Jagmeet Singh MD, DM, Jagmeet Singh MD, DM Department of Cardiology King Edward VII Memorial Hospital Parel, Bombay, IndiaSearch for more papers by this authorYash Lokhandwala MD, DM, Yash Lokhandwala MD, DM Department of Cardiology King Edward VII Memorial Hospital Parel, Bombay, IndiaSearch for more papers by this authorPurshottam Kale MD, Purshottam Kale MD Department of Cardiology King Edward VII Memorial Hospital Parel, Bombay, IndiaSearch for more papers by this author Jagmeet Singh MD, DM, Jagmeet Singh MD, DM Department of Cardiology King Edward VII Memorial Hospital Parel, Bombay, IndiaSearch for more papers by this authorYash Lokhandwala MD, DM, Yash Lokhandwala MD, DM Department of Cardiology King Edward VII Memorial Hospital Parel, Bombay, IndiaSearch for more papers by this authorPurshottam Kale MD, Purshottam Kale MD Department of Cardiology King Edward VII Memorial Hospital Parel, Bombay, IndiaSearch for more papers by this author First published: March 1994 https://doi.org/10.1002/ccd.1810310325AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume31, Issue3March 1994Pages 253-254 SCAI Member Sign in RelatedInformation

Percutaneous inferior vena cava placement of tunneled silastic catheters for prolonged vascular access in infants

In infants and children requiring prolonged and multiple central venous catheterizations, conventional cannulation sites may become thrombosed or stenotic, making inability to gain vascular access a life-threatening problem. The technique we use for the percutaneous placement of inferior vena caval tunneled silastic catheters via the translumbar and transhepatic approaches is described. Three translumbar placements and one transhepatic placement in three children without immediate complications have been performed. We conclude that percutaneous inferior vena caval cannulation via the translumbar or transhepatic routes offers a viable alternative in these patients with difficult vascular access.