1
|
Gaballah M, Durand R, Srinivasan A, Katcoff H, Cahill AM, Otero HJ. Central venous access in children: Placement trends over the last decade. Clin Imaging 2023; 97:84-88. [PMID: 36921450 DOI: 10.1016/j.clinimag.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/23/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE To evaluate central venous access placement trends for radiology and non-radiology services over the last decade. MATERIALS AND METHODS Children who had central venous access procedures included in a large administrative database of 49 pediatric institutions in the United States between 2010 and 2020 were included. Patient demographics and patient specific factors were compared between groups. The percentage of procedures performed by interventional radiology (IR) and non-radiology services were compared over time and by region. RESULTS A total of 483,181 vascular access encounters were recorded (45.3% female; median age 2 years (IQR 0-11 years)). Approximately one quarter of vascular access encounters were IR-led, with a slight increase of 3.8% between 2010 and 2020. Children who underwent IR-placed vascular access were older (median age of 4 years compared to 1 year in non-radiology encounters). Interventional radiology-placed access was greatest in the Midwest (33.5%) with a decrease of 5.9% over the study period; in the other three regions, IR-performed encounters increased. Patient comorbidities more prevalent in the IR encounters were technology dependence (42.4% of all radiology encounters), gastrointestinal (34.9%), respiratory (20.8%), and transplant (8.1%), while those which were more prevalent in the non-radiology encounters were nephrology/urology (21.4% of all non-radiology encounters), prematurity/neonatal (17.3%), and malignancy (17.3%). CONCLUSIONS Interventional radiology-provided vascular access services have slightly increased over the last decade without significant service-line transfer to other specialties. Underlying comorbidities in IR-led vascular access encounters vary across institutions based on referral patterns, possibly reflecting the adoption of ultrasound guidance by other pediatric subspecialties.
Collapse
Affiliation(s)
- Marian Gaballah
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Rachelle Durand
- Department of Radiology and Biomedical Imaging, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, CA 94158, USA
| | - Abhay Srinivasan
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hannah Katcoff
- Center for Pediatric Clinical Effectiveness at the Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Anne Marie Cahill
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
2
|
Angiography and Pre-operative Embolization of an Extra-axial, Supratentorial Atypical Teratoid Rhabdoid Tumor. Can J Neurol Sci 2023; 50:294-296. [PMID: 34974852 DOI: 10.1017/cjn.2021.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
3
|
Augustin AM, Kertels O, Wiegering V, Thurner A, Kickuth R. Percutaneous implantation of peripherally inserted totally implantable venous access systems in the forearm in adolescent patients. Pediatr Radiol 2022; 52:1550-1558. [PMID: 35368211 PMCID: PMC9271099 DOI: 10.1007/s00247-022-05321-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/14/2022] [Accepted: 02/11/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Children with different underlying malignant diseases require long-term central venous access. As for port systems in a pectoral position, peripherally implanted port systems in the forearm revealed high levels of technical and clinical success in adult cohorts. OBJECTIVE To investigate the technical and clinical outcomes of percutaneous central venous port implantation in the forearm in adolescents. MATERIALS AND METHODS Between April 2010 and August 2020, 32 children ages 9 to 17 years with underlying malignancy received 35 totally implantable venous access ports (TIVAPs) in the forearm. All venous port systems were peripherally inserted under ultrasound guidance. Correct catheter placement was controlled by fluoroscopy. As primary endpoints, the technical success, rate of complications and catheter maintenance were analyzed. Secondary endpoints were the side of implantation, vein of catheter access, laboratory results on the day of the procedure, procedural radiation exposure, amount of contrast agent and reasons for port device removal. RESULTS Percutaneous TIVAP placement under sonographic guidance was technically successful in 34 of 35 procedures (97.1%). Procedure-related complications did not occur. During the follow-up, 13,684 catheter days were analyzed, revealing 11 complications (0.8 per 1,000 catheter-duration days), Of these 11 complications, 7 were major and 10 occurred late. In seven cases, the port device had to be removed; removal-related complications did not occur. CONCLUSION Peripheral TIVAP placement in the forearms of children is a feasible, effective and safe technique with good midterm outcome. As results are comparable with standard access routes, this technique may be offered as an alternative when intermittent venous access is required.
Collapse
Affiliation(s)
- Anne Marie Augustin
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Strasse 6, DE 97080, Würzburg, Germany.
| | - Olivia Kertels
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Strasse 6, DE 97080 Würzburg, Germany
| | - Verena Wiegering
- Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany
| | - Annette Thurner
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Strasse 6, DE 97080 Würzburg, Germany
| | - Ralph Kickuth
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Strasse 6, DE 97080 Würzburg, Germany
| |
Collapse
|
4
|
Johansen M, Classen V, Muchantef K. Long-term IV access in paediatrics - why, what, where, who and how. Acta Anaesthesiol Scand 2021; 65:282-291. [PMID: 33147351 DOI: 10.1111/aas.13729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/06/2020] [Accepted: 10/15/2020] [Indexed: 11/26/2022]
Abstract
Establishment of long-term central venous access imposes the risk of procedural adverse events (air embolism, pneumothorax, accidental arterial cannulation of the great vessels, tricuspid valve damage and cardiac tamponade) as well as the risk of increased morbidity and mortality due to catheter related blood stream infections, vessel stenosis, deep vein thrombosis and the often high risk anaesthetic management of syndromic children. This narrative review aims to provide a historical and clinical background for the development and use of CVADs (central venous access devices), origin and management of the most common complications (catheter related thrombosis, infections and persistent withdrawal occlusion) and present the reader with an update on the "why, what, where, who and how" in paediatric long-term central venous access. Finally, we will present the reader with a clinical method for applying a retrograde inserted tunnelled and cuffed catheter using the left brachiocephalic vein access.
Collapse
Affiliation(s)
- Mathias Johansen
- Department of Paediatric Anaesthesia Montreal Children's Hospital Montreal Canada
| | - Volker Classen
- Department of Paediatric Anaesthesia Rigshospitalet Copenhagen Denmark
| | - Karl Muchantef
- Department of Interventional Radiology Montreal Children's Hospital Montreal Canada
| |
Collapse
|
5
|
Ballard HA, Tsao M, Robles A, Phillips M, Hajduk J, Feinglass J, Barsuk JH. Use of a simulation-based mastery learning curriculum to improve ultrasound-guided vascular access skills of pediatric anesthesiologists. Paediatr Anaesth 2020; 30:1204-1210. [PMID: 32594590 DOI: 10.1111/pan.13953] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/14/2020] [Accepted: 06/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pediatric vascular access is inherently challenging due to the small caliber of children's vessels. Ultrasound-guided intravenous catheter insertion has been shown to increase success rates and decrease time to cannulation in patients with difficult intravenous access. Although proficiency in ultrasound-guided intravenous catheter insertion is a critical skill in pediatric anesthesia, there are no published competency-based training curricula. AIMS The objective of this study was to evaluate the performance of pediatric anesthesiologists who participated in a novel ultrasound-guided intravenous catheter insertion simulation-based mastery learning curriculum. METHODS Pediatric anesthesia attendings, fellows, and rotating residents participated in the ultrasound-guided intravenous catheter insertion simulation-based mastery learning curriculum from August 2019 to February 2020. The 2-hour curriculum consisted of participants first undergoing a simulated skills pretest followed by watching a video on ultrasound-guided intravenous catheter insertion and deliberate practice on a simulator. Subsequently, all participants took a post-test and were required to meet or exceed a minimum passing standard. Those who were unable to meet the minimum passing standard participated in further practice until they could be retested and met this standard. We compared pre to post-test ultrasound-guided intravenous catheter insertion skills and self-confidence before and after participation in the curriculum. RESULTS Twenty-six pediatric anesthesia attendings, 12 fellows, and 38 residents participated in the curriculum. At pretest, 16/76 (21%) participants were able to meet or exceed the minimum passing standard. The median score on the pretest was 21/25 skills checklist items correct and improved to 24/25 at post-test (95% CI 3.0-4.0, P < .01). Self-confidence significantly improved after the course from an average of 3.2 before the course to a postcourse score of 3.9 (95% CI 0.5-0.9, P < .01; 1 = Not all confident, 5 = Very confident). CONCLUSIONS Simulation-based mastery learning significantly improved anesthesiologists' ultrasound-guided intravenous catheter insertion performance in a simulated setting.
Collapse
Affiliation(s)
- Heather A Ballard
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA.,Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Michelle Tsao
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA.,Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Alison Robles
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA.,Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Mitch Phillips
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA.,Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - John Hajduk
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA.,Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Joseph Feinglass
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.,Department of Medicine, Northwestern Memorial Hospital, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey H Barsuk
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.,Department of Medicine, Northwestern Memorial Hospital, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
6
|
Lawson BT, Zealley IA. Adult 'PICC' Device May be Used as a Tunnelled Central Venous Catheter in Children. Cardiovasc Intervent Radiol 2018; 41:645-652. [PMID: 29344711 PMCID: PMC5838138 DOI: 10.1007/s00270-017-1860-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 12/14/2017] [Indexed: 11/05/2022]
Abstract
Purpose Central venous access in children, in particular small children and infants, is challenging. We have developed a technique employing adult peripherally inserted central venous catheters (PICCs) as tunnelled central venous catheters (TCVCs) in children. The principal advantage of this novel technique is that the removal technique is less complex than that of conventional cuffed TCVCs. The catheter can be removed simply by being pulled out and does not require general anaesthesia. The purpose of this study is to determine the success, safety and utility of this technique and to identify the rate of late complications. We describe the 6-year experience in our unit. Materials and Methods Electronic and paper medical records were reviewed for consecutive paediatric patients who had a PICC device inserted as a TCVC over a 6-year period (September 2009 through July 2015). The following data were recorded—patient demographics, setting for PICC as TCVC insertion, use of ultrasound and fluoroscopy, PICC device type, early or late complications and date of and reason for removal. Results Twenty-one PICCs were inserted as TCVCs in 19 children, all aged less than 10 years. Mean patient age at the time of placement was 3.7 years. Average patient weight was 15.7 kg. All insertions were successful with no significant immediate complications recorded. The most common indication for insertion in our patient sample was pseudo-obstruction secondary to gastrointestinal dysmotility disorder (24%), with cystic fibrosis infective exacerbation being the second most frequent diagnosis (14%). Suspected catheter-related infection led to early device removal in one case (4.8%). Inadvertent dislodgement occurred in one case (4.8%). Nineteen of the 21 devices (90.4%) lasted for the total intended duration of use. Conclusion Using a PICC device as a TCVC in small children appears to be a safe technique, with an acceptable complication profile.
Collapse
Affiliation(s)
- Brooke T Lawson
- Department of Radiology, Ninewells Hospital, Dundee, DD1 9SY, Scotland, UK.
| | - Ian A Zealley
- Department of Radiology, Ninewells Hospital, Dundee, DD1 9SY, Scotland, UK
| |
Collapse
|
7
|
Montes-Tapia F, Rodríguez-Taméz A, Cura-Esquivel I, Barreto-Arroyo I, Hernández-Garduño A, Rodríguez-Balderrama I, Quero J, de la O-Cavazos M. Efficacy and safety of ultrasound-guided internal jugular vein catheterization in low birth weight newborn. J Pediatr Surg 2016; 51:1700-3. [PMID: 27292594 DOI: 10.1016/j.jpedsurg.2016.05.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/16/2016] [Accepted: 05/21/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Central venous catheterization is not the first choice of vascular access in neonates. Success depends on the size of the vessel and the skill of the health professional performing the procedure. The internal jugular vein provides a predictable path for central venous cannulation, although it is more difficult to cannulate infants than adults and even more difficult in smaller newborns. METHODS We conducted a prospective study in 100 newborns, in which a 4 Fr ultrasound-guided central venous catheter was placed in the right internal jugular vein (RIJV). The study population was low birth weight (LBW) newborns <2500g, very low birth weight (VLBW) newborns <1500g and extremely low birth weight (ELBW) newborns <1000g. RESULTS There were 53% female patients, mean gestational age was 31weeks, mean weight 1352g and the CVC was placed at a mean of 12days of extrauterine life. Birth weight distribution was 39% LBW; 33% VLBW and 28% ELBW. A mean of two (1-8) attempts were necessary with a procedure duration of 16.8 (10-40) minutes. Success of RIJV catheterization was 94%. One attempt was necessary in 50% and up to 5 attempts in 95.7%. Success by weight was VLBW, 97.2%; ELBW, 92.9%; LBW, 91.7%. A venous hematoma occurred in 5% of cases. CONCLUSIONS Ultrasound-guided RIJV cannulation with real-time visualization to gain access to the central venous circulation in low birth weight newborns is effective and safe.
Collapse
Affiliation(s)
- Fernando Montes-Tapia
- Department of Pediatrics, Hospital Universitario, Universidad Autónoma de Nuevo León, Av. Madero y Gonzalitos s/n, Monterrey, N.L. 66451.
| | - Antonio Rodríguez-Taméz
- Department of Pediatrics, Hospital Universitario, Universidad Autónoma de Nuevo León, Av. Madero y Gonzalitos s/n, Monterrey, N.L. 66451
| | - Idalia Cura-Esquivel
- Department of Pediatrics, Hospital Universitario, Universidad Autónoma de Nuevo León, Av. Madero y Gonzalitos s/n, Monterrey, N.L. 66451
| | - Itzel Barreto-Arroyo
- Department of Pediatrics, Hospital Universitario, Universidad Autónoma de Nuevo León, Av. Madero y Gonzalitos s/n, Monterrey, N.L. 66451
| | - Adolfo Hernández-Garduño
- Department of Pediatrics, Hospital Universitario, Universidad Autónoma de Nuevo León, Av. Madero y Gonzalitos s/n, Monterrey, N.L. 66451
| | - Isaías Rodríguez-Balderrama
- Department of Pediatrics, Hospital Universitario, Universidad Autónoma de Nuevo León, Av. Madero y Gonzalitos s/n, Monterrey, N.L. 66451
| | - José Quero
- Facultad de Medicina, Universidad Autónoma de Madrid, C/Arzobispo Morcillo 4 Madrid, Madrid, ES 28029
| | - Manuel de la O-Cavazos
- Department of Pediatrics, Hospital Universitario, Universidad Autónoma de Nuevo León, Av. Madero y Gonzalitos s/n, Monterrey, N.L. 66451
| |
Collapse
|
8
|
|
9
|
Comparison between radiation exposure levels using an image intensifier and a flat-panel detector-based system in image-guided central venous catheter placement in children weighing less than 10 kg. Pediatr Radiol 2015; 45:235-40. [PMID: 25204662 DOI: 10.1007/s00247-014-3119-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 04/09/2014] [Accepted: 07/10/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Ultrasound-guided central venous puncture and fluoroscopic guidance during central venous catheter (CVC) positioning optimizes technical success and lowers the complication rates in children, and is therefore considered standard practice. OBJECTIVE The purpose of this study was to compare the radiation exposure levels recorded during CVC placement in children weighing less than 10 kg in procedures performed using an image intensifier-based angiographic system (IIDS) to those performed in a flat-panel detector-based interventional suite (FPDS). MATERIALS AND METHODS A retrospective review of 96 image-guided CVC placements, between January 2008 and October 2013, in 49 children weighing less than 10 kg was performed. Mean age was 8.2 ± 4.4 months (range: 1-22 months). Mean weight was 7.1 ± 2.7 kg (range: 2.5-9.8 kg). The procedures were classified into two categories: non-tunneled and tunneled CVC placement. RESULTS Thirty-five procedures were performed with the IIDS (21 non-tunneled CVC, 14 tunneled CVC); 61 procedures were performed with the FPDS (47 non-tunneled CVC, 14 tunneled CVC). For non-tunneled CVC, mean DAP was 113.5 ± 126.7 cGy cm(2) with the IIDS and 15.9 ± 44.6 cGy · cm(2) with the FPDS (P < 0.001). For tunneled CVC, mean DAP was 84.6 ± 81.2 cGy · cm(2) with the IIDS and 37.1 ± 33.5 cGy cm(2) with the FPDS (P = 0.02). CONCLUSION The use of flat-panel angiographic equipment reduces radiation exposure in small children undergoing image-guided CVC placement.
Collapse
|
10
|
Maitta RW, Vasovic LV, Mohandas K, Music-Aplenc L, Bonzon-Adelson A, Uehlinger J. A safe therapeutic apheresis protocol in paediatric patients weighing 11 to 25 kg. Vox Sang 2014; 107:375-80. [PMID: 24912805 DOI: 10.1111/vox.12164] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 04/16/2014] [Accepted: 05/07/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Erythrocytapheresis and leukapheresis (LPE) of small children are logistically complex and many centres are reluctant to perform these procedures. In children, both sickle cell and leukaemic emergencies demand prompt action to prevent additional morbidity but detailed protocols for small children are lacking, and often are performed using guidelines shown to work in larger patients. We report a 3-year experience with children weighing 11-25 kg at a large academic medical centre. MATERIALS AND METHODS All patients were treated with the COBE® Spectra apheresis system; circuit was primed with blood not adjusted for haematocrit and anticoagulant citrate dextrose A was used as anticoagulation. Procedures were performed in the paediatric intensive care unit by apheresis nursing staff. RESULTS Twenty-five apheresis procedures in 19 patients were performed; 17 of 19 patients presented with sickle cell-related acute complications and two (2/19) with newly diagnosed acute leukaemia and hyperleucocytosis. None of the patients required medications during the procedures. Vital signs and clinical condition remained stable and did not worsen during or postapheresis. One patient had a delayed haemolytic transfusion reaction 1 week posterythrocytapheresis as he developed alloantibodies as a result of the procedure. All sickle cell patients achieved a target haematocrit of 21-30% and Haemoglobin A of ≥68%. Both leukaemia patients who underwent LPE had no further signs of leukostasis and achieved marked reductions in leucocyte counts. CONCLUSIONS Apheresis of children weighing 11-25 kg can be safely performed without increased morbidity. We outline a protocol that can be used to perform apheresis with minimal complications.
Collapse
Affiliation(s)
- R W Maitta
- Departments of Pathology, University Hospitals Case Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | | | | | | | | |
Collapse
|
11
|
Montes-Tapia F, Rodríguez-Taméz A, Hernandez-Garduño A, Barreto-Arroyo I, Rodríguez-Balderrama I, de la O-Cavazos M, Quero J. Vascular assessment of the right internal jugular vein in low birth weight newborns. J Matern Fetal Neonatal Med 2013; 26:1510-3. [DOI: 10.3109/14767058.2013.789853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
12
|
Heran MKS, Burrill J. Vascular pediatric interventional radiology. Can Assoc Radiol J 2012; 63:S59-73. [PMID: 22658372 DOI: 10.1016/j.carj.2011.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Revised: 09/20/2011] [Accepted: 12/09/2011] [Indexed: 12/13/2022] Open
Abstract
Interventional radiology procedures are increasingly in demand in both the adult and pediatric populations. Pediatric procedures mirror many of the adult procedures but with increased complexity due to many considerations, notably patient size. This article reviews the various vascular pediatric interventional procedures. The aim is to provide a greater exposure to the possible treatment options for pediatric patients and to facilitate understanding of the success and complications rates related to various interventions.
Collapse
Affiliation(s)
- Manraj K S Heran
- Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada.
| | | |
Collapse
|
13
|
Wong EC, Balogun RA. Therapeutic apheresis in pediatrics: Technique adjustments, indications and nonindications, a plasma exchange focus. J Clin Apher 2012; 27:132-7. [DOI: 10.1002/jca.21224] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Accepted: 02/21/2012] [Indexed: 01/04/2023]
|
14
|
Castillo D, McEwen DS, Young L, Kirkpatrick J. Micropuncture needles combined with ultrasound guidance for unusual central venous cannulation: desperate times call for desperate measures--a new trick for old anesthesiologists. Anesth Analg 2011; 114:634-7. [PMID: 22190551 DOI: 10.1213/ane.0b013e3182411c4e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Central vascular access can be a very challenging task in patients with skeletal deformities such as ankylosing spondylitis, kyphosis, and chin-on-chest deformity. The use of traditional methods of accessing the central venous circulation in these patients can require multiple attempts and may lead to significant complications such as bleeding, pneumothorax, and vascular injury. Ultrasound-guided central venous access has become a very common procedure in the United States and Europe; its efficacy and safety have been demonstrated, and together with the use of micropuncture needles, the technique can facilitate central venous access in complicated cases.
Collapse
Affiliation(s)
- Daniel Castillo
- Department of Anesthesiology, University of Florida College of Medicine-Jacksonville, 655 West Eighth Street, Jacksonville, FL 32209, USA.
| | | | | | | |
Collapse
|
15
|
Braswell LE. Peripherally Inserted Central Catheter Placement in Infants and Children. Tech Vasc Interv Radiol 2011; 14:204-11. [DOI: 10.1053/j.tvir.2011.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
16
|
Krishnamurthy G, Keller MS. Vascular Access in Children. Cardiovasc Intervent Radiol 2010; 34:14-24. [DOI: 10.1007/s00270-010-9865-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 02/18/2010] [Indexed: 11/24/2022]
|
17
|
Wells JM, Jawaid WB, Bromley P, Bennett J, Arul GS. A dedicated consultant-led vascular access team significantly reduces out-of-hours and emergency permanent central venous access insertions. J Pediatr Surg 2010; 45:419-21. [PMID: 20152365 DOI: 10.1016/j.jpedsurg.2009.10.089] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2009] [Accepted: 10/27/2009] [Indexed: 11/19/2022]
Abstract
PURPOSE The insertion of a permanent central venous access device (PCVAD i.e. Broviac or Hickman lines and vascuports) is often considered a low priority and performed as an emergency. In 2004, a vascular access team (VAT), responsible for all PCVAD insertions, was established in our institution to address this. METHODS Data were collected retrospectively on all PCVAD insertions in 2 periods (January 2002-December 2003 and January 2005-December 2006). This included procedure, list type, surgeon grade, and operative time. RESULTS During 2002 to 2003 and 2005 to 2006, 465 and 569 PCVADs were inserted, respectively (22% increase). After introduction of the VAT, the percentage of lines inserted during emergency lists fell from 24% (n = 112) to 13% (n = 72), and out-of-hours fell from 6% (n = 29) to 3% (n = 17; P < .05), respectively. Median time taken for PCVAD insertion in 2005 to 2006 was significantly less if using an elective list compared with insertions performed on an emergency list (elective, 67 [56-82] minutes vs emergency, 85 (65-110) minutes; P < .05). DISCUSSION Introduction of a VAT has led to a significant decrease in emergency and out-of-hours PCVAD insertions, despite an increase in overall activity for the period. The median time taken for elective insertions is significantly less than emergency insertions, which has increased the efficiency of vascular access provision at our institution.
Collapse
Affiliation(s)
- John M Wells
- Department of Pediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, B4 6NH Birmingham, UK
| | | | | | | | | |
Collapse
|