Abstract
Ultrasound guided central venous cannulation is rapidly becoming the standard technique for achieving a central line in neonates, infants and children. Older techniques such as surgical cutdown and ‘blind’ percutaneous venipuncture have many disadvantages: they are time consuming, vein consuming and/or associated with dangerous immediate or late complications. On the other hand, ultrasound has only advantages, giving the operator the possibility of (a) choosing the most appropriate and safest venous access on the basis of ultrasound assessment, (b) performing a 100% safe insertion, (c) ruling out malpositions or pleuro-pulmonary damages, during and after the procedure. Ultrasound guided central venous cannulation has been described in many clinical studies of the last decade, each one showing the higher efficacy and safety of ultrasound guidance in children when compared to the traditional landmark method. Ultrasound can be used for puncturing many different deep veins of the arm, neck, groin and thorax. The vein can be visualized either in short axis or in long axis, while the puncture can be performed ‘in-plane’ (when the needle trajectory is included in the plane of the ultrasound probe) or ‘out-of-plane’ (when the needle trajectory is not in that plane). Though, the best clinical results of ultrasound guidance can be achieved - particularly in neonates and infants - only if the operator has been properly trained in this technique through an appropriate curriculum that should include theory lessons, simulation practice and a tutored learning curve.
Keywords: Central venous access, central venous catheters, PICC, ultrasound guidance, venipuncture, neonates, ultrasound, Central lines, short axis, long axis
Current Drug Targets
Title:Ultrasound Guided Central Vascular Access in Neonates, Infants and Children
Volume: 13 Issue: 7
Author(s): Mauro Pittiruti
Affiliation:
Keywords: Central venous access, central venous catheters, PICC, ultrasound guidance, venipuncture, neonates, ultrasound, Central lines, short axis, long axis
Abstract: Ultrasound guided central venous cannulation is rapidly becoming the standard technique for achieving a central line in neonates, infants and children. Older techniques such as surgical cutdown and ‘blind’ percutaneous venipuncture have many disadvantages: they are time consuming, vein consuming and/or associated with dangerous immediate or late complications. On the other hand, ultrasound has only advantages, giving the operator the possibility of (a) choosing the most appropriate and safest venous access on the basis of ultrasound assessment, (b) performing a 100% safe insertion, (c) ruling out malpositions or pleuro-pulmonary damages, during and after the procedure. Ultrasound guided central venous cannulation has been described in many clinical studies of the last decade, each one showing the higher efficacy and safety of ultrasound guidance in children when compared to the traditional landmark method. Ultrasound can be used for puncturing many different deep veins of the arm, neck, groin and thorax. The vein can be visualized either in short axis or in long axis, while the puncture can be performed ‘in-plane’ (when the needle trajectory is included in the plane of the ultrasound probe) or ‘out-of-plane’ (when the needle trajectory is not in that plane). Though, the best clinical results of ultrasound guidance can be achieved - particularly in neonates and infants - only if the operator has been properly trained in this technique through an appropriate curriculum that should include theory lessons, simulation practice and a tutored learning curve.
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Cite this article as:
Pittiruti Mauro, Ultrasound Guided Central Vascular Access in Neonates, Infants and Children, Current Drug Targets 2012; 13 (7) . https://dx.doi.org/10.2174/138945012800675696
DOI https://dx.doi.org/10.2174/138945012800675696 |
Print ISSN 1389-4501 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-5592 |
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