Skip to main content
SpringerLink
Log in

Vascular Access in the Perioperative Period

  • Chapter
Perioperative Medicine in Pediatric Anesthesia

Abstract

Vascular access is of major importance in the perioperative period. Anesthesiologist and pediatricians, as experts, should master their techniques and have a thorough knowledge of the existing tools that could assist difficult vascular accesses.

The intraosseous route, often limited to prehospital settings, should be reconsidered in the hospital and the operating rooms for life-threatening situations since easy-to-use devices were developed. For the same reasons, in the perinatal period, the umbilical access is a rapid, safe, and efficient temporary access.

Bedside ultrasound examination and real-time needle guidance are the most important progress made over the last decade to facilitate vascular access and reduce complications. A broad range of techniques have been developed far beyond the puncture of the internal jugular vein: difficult peripheral access, arterial access, and femoral and periclavicular central venous access. The learning curve to apply these techniques in children, and especially in neonates, is not so short and should be followed carefully. New types of catheters, from long peripheral cannula’s or “midlines” to peripherally inserted central catheters (PICCs), complete the panel of available devices allowing the practitioner to find the most appropriate access regarding the child’s needs. Since ultrasound reduces the incidence of immediate catheter-related complications, our focus should now be set on decreasing late complications by choosing the right device, the most accurate placement technique, and the optimal care for these catheters.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Pirotte T (2008) Ultrasound-guided vascular access in adults and children: beyond the internal jugular vein. Acta Anaesth Belg 59:157–166

    PubMed  Google Scholar 

  2. NICE (2002) Guidance on the used of ultrasound location devices for placing central venous catheters. Technology appraisal guidance 49. http://www.nice.org.uk/guidance/TA49

  3. Rupp SM, Apfelbaum JL, Blitt C et al (2012) Practical guidelines for central venous access: a report by the American society of Anesthesiologist task force on central venous access. Anesthesiology 116:539–573

    Article  PubMed  Google Scholar 

  4. Troianos C, Hartman G, Glas K et al (2012) Guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. Anesth Analg 114:46–72

    Article  PubMed  Google Scholar 

  5. Lamperti M, Bodenham AR, Pittiruti M et al (2012) International evidence-based recommendations on ultrasound-guided vascular access. Intensive Care Med 38:1105–1117

    Article  PubMed  Google Scholar 

  6. Zetlaoui P, Bouaziz H, Pierre S et al (2014) Recommandation sur l’utilisation de l’échographie lors de la mise en place des accès vasculaires. French Society of Anesthesia and Reanimation. http://www.sfar.org/article/1209/rfe-recommandations-sur-l-rsquo-utilisation-de-l-rsquo-echographie-lors-de-la-mise-en-place-des-acces-vasculaires. Accessed 10 Apr 2015

  7. Cuper NJ, de Graaff JC, van Dijk AT et al (2012) Predictive factors for difficult intravenous cannulation in pediatric patients at a tertiary pediatric hospital. Pediatr Anesth 22:223–229

    Article  Google Scholar 

  8. Yen K, Riegert A, Gorelick MH (2008) Derivation of the DIVA score: a clinical prediction rule for the identification of children with difficult intravenous access. Pediatr Emerg Care 24:143–147

    Article  PubMed  Google Scholar 

  9. Hosokawa K, Kato H, Kishi C et al (2010) Transillumination by light-emitting diode facilitates peripheral venous cannulations in infants and small children. Acta Anaesthesiol Scand 54:957–961

    Article  CAS  PubMed  Google Scholar 

  10. de Graaff JC, Cuper NJ, Mungra A et al (2013) Near-infrared light to aid peripheral intravenous cannulation in children: a cluster randomised trial of three devices. Anaesthesia 68:835–845

    Article  PubMed  Google Scholar 

  11. van der Woude OC, Cuper NJ, Getrouw C et al (2013) The effectiveness of a near-infrared vascular imaging device to support intravenous cannulation in children with dark skin color: a cluster randomized clinical trial. Anesth Analg 116:1266–1271

    Article  PubMed  Google Scholar 

  12. Benkhadra M, Collignon M, Fournel I et al (2012) Ultrasound guidance allows faster peripheral IV cannulation in children under 3 years of age with difficult venous access: a prospective randomized study. Pediatr Anesth 22:449–454

    Article  Google Scholar 

  13. Heinrichs J, Fritze Z, Vandermeer B et al (2013) Ultrasonographically guided peripheral intravenous cannulation of children and adults: a systematic review and meta-analysis. Ann Emerg Med 61:444–454

    Article  PubMed  Google Scholar 

  14. Centers for Disease Control and Prevention (CDC) (2011) Vital signs: central line-associated blood stream infection – United States 201, 2008 and 2009. Morb Mortal Wkly Rep 60:243–248

    Google Scholar 

  15. Kim H, Jeong CH, Byon HJ et al (2013) Prediction of the optimal depth of left-sided central venous catheters in children. Anaesthesia 68:1033–1037

    Article  CAS  PubMed  Google Scholar 

  16. Choi M, Massicotte P, Marzinotto V et al (2001) The use of alteplase to restore patency of central venous lines in pediatric patients: a cohort study. J Pediatr 139:152–156

    Article  CAS  PubMed  Google Scholar 

  17. Roth B, Marciniak B, Engelhardt T et al (2008) Anatomic relationship between the internal jugular vein and the carotid artery in preschool children: an ultrasonographic study. Pediatr Anesth 18:752–756

    Article  Google Scholar 

  18. Arai T, Matsuda Y, Koizuka K et al (2009) Rotation of the head might not be recommended for internal jugular puncture in infants and children. Pediatr Anesth 19:844–847

    Article  Google Scholar 

  19. Morita M, Sasano H, Azami T et al (2009) A novel skin-traction method is effective for real time ultrasound-guided internal jugular vein catheterization in infants and neonates weighing less than 5 kilograms. Anesth Analg 109:754–759

    Article  PubMed  Google Scholar 

  20. Verghese S, McGill W, Patel R et al (1999) Ultrasound-guided internal jugular vein cannulation in infants: a prospective comparison with the traditional palpation method. Anesthesiology 91:71–77

    Article  CAS  PubMed  Google Scholar 

  21. Phelan M, Hagerty D (2009) The oblique view: an alternative approach for ultrasound-guided central line placement. J Emerg Med 37:403–408

    Article  PubMed  Google Scholar 

  22. Rhondali O, Attof R, Combet S et al (2011) Ultrasound-guided subclavian vein cannulation in infants: supraclavicular approach. Pediatr Anesth 21:1136–1141

    Article  Google Scholar 

  23. Breschan C, Platzer M, Jost R et al (2011) Consecutive, prospective case series of a new method for ultrasound-guided supraclavicular approach to the brachiocephalic vein in children. Br J Anaesth 106:732–737

    Article  CAS  PubMed  Google Scholar 

  24. Breschan C, Platzer M, Jost R et al (2012) Ultrasound-guided supraclavicular cannulation of the brachiocephalic vein in infants: a retrospective analysis of a case series. Pediatr Anesth 22:1062–1067

    Google Scholar 

  25. Byon HJ, Lee GW, Lee JH et al (2013) Comparison between ultrasound-guided supraclavicular and infraclavicular approaches for subclavian venous catheterization in children – a randomized trial. Br J Anaesth 111:788–792

    Article  PubMed  Google Scholar 

  26. Pirotte T, Veyckemans F (2007) Ultrasound-guided subclavian vein cannulation in infants and children: a novel approach. Br J Anaesth 98:509–514

    Article  CAS  PubMed  Google Scholar 

  27. O’Leary R, Ahmed SM, McLure H et al (2012) Ultrasound-guided infraclavicular axillary vein cannulation: a useful alternative to the internal jugular vein. Br J Anaesth 109:762–768

    Article  PubMed  Google Scholar 

  28. Suk EH, Kim DH, Kil HK et al (2009) Effects of reverse Trendelenburg position and inguinal compression on femoral vein cross-sectional area in infants and young children. Anaesthesia 64:399–402

    Article  CAS  PubMed  Google Scholar 

  29. Warkentine FH, Pierce MC, Lorenz D et al (2008) The anatomic relationship of femoral vein to femoral artery in euvolemic pediatric patients by ultrasonography: implication for pediatric femoral central venous access. Acad Emerg Med 15:426–430

    Article  PubMed  Google Scholar 

  30. Shinohara Y, Arai T, Yamashita M (2005) The optimal insertion length of central venous catheter via the femoral route for open heart surgery in infants and children. Pediatr Anesth 15:12–124

    Article  Google Scholar 

  31. Aouad MT, Kanazi GE, Abdallah FW et al (2010) Femoral vein cannulation performed by residents: a comparison between ultrasound-guided and landmark technique in infants and children undergoing cardiac surgery. Anesth Analg 111:724–728

    Article  PubMed  Google Scholar 

  32. Bouchut JC, Floret D (2006) Radiographic confirmation following pediatric femoral venous cannulation. Can J Anesth 53:422–423

    Article  PubMed  Google Scholar 

  33. Westergaard B, Classen V, Walther-Larsen S (2013) Peripherally inserted central catheters in infants and children – indications, techniques, complications and clinical recommendations. Acta Anaesthesiol Scand 57:278–287

    Article  CAS  PubMed  Google Scholar 

  34. Abedin S, Kapoor G (2008) Peripherally inserted central venous catheters are a good option for prolonged venous access in children with cancer. Pediatr Blood Cancer 51:251–255

    Article  PubMed  Google Scholar 

  35. Barrier A, Williams D, Connely M (2011) Frequency of peripherally inserted central catheter complication in children. Pediatr Infect Dis J 31:519–521

    Article  Google Scholar 

  36. Advani S, Reich N, Sengupta A et al (2011) Central line-associated bloodstream infection in hospitalized children with peripherally inserted central venous catheters: extending risk analyzes outside the intensive care unit. Clin Infect Dis 52:1108–1115

    Article  PubMed Central  PubMed  Google Scholar 

  37. Dubois J, Rypens F, Garel L et al (2007) Incidence of deep vein thrombosis related to peripherally inserted central catheters in children and adolescents. CMAJ 177:1185–1190

    Article  PubMed Central  PubMed  Google Scholar 

  38. Weiss M, Engelhardt T (2012) Cannot cannulate: bonulate! Eur J Anesthesiol 29:257–258

    Article  Google Scholar 

  39. Anson JA (2014) Vascular access in resuscitation: is there a role for the intraosseous route? Anesthesiology 120:1015–1031

    Article  PubMed  Google Scholar 

  40. Hallas P, Brabrand M, Folkestad L (2013) Complication with intraosseous access: Scandinavian users’ experience. West J Emerg Med 14:440–443

    Article  PubMed Central  PubMed  Google Scholar 

  41. Schwemmer U, Arzet HA, Trautner H et al (2006) Ultrasound-guided arterial cannulation in infants improves success rate. Eur J Anaesthesiol 23:476–480

    Article  CAS  PubMed  Google Scholar 

  42. Ishii S, Shime N, Shibasaki M et al (2013) Ultrasound-guided radial artery catheterization in infants and small children. Ped Anesth 14:471–473

    Google Scholar 

  43. Anderson J, Leonard D, Braner D et al (2008) Umbilical vascular catheterization. N Engl J Med 359, e18

    Article  PubMed  Google Scholar 

  44. Schlesinger AE, Braveman R, DiPietro MA (2003) Neonates and umbilical venous catheter: normal appearance, anomalous positions, complications and potential aids to diagnosis. Am J Roentgenol 180:1147–1153

    Article  Google Scholar 

  45. Ji Hye K, Young Seok L, Sang Hee K et al (2001) Does umbilical vein catheterization lead to portal vein thrombosis? Prospective US evaluation in 100 neonates. Radiology 219:645–650

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesia, Cliniques universitaires Saint-Luc, Université catholique de Louvain – UCL, Brussels, Belgium

    Thierry Pirotte

Authors
  1. Thierry Pirotte
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thierry Pirotte .

Editor information

Editors and Affiliations

  1. UCO di Anestesia e Rianimazione, AO-U Policlinico di Catania, Catania, Italy

    Marinella Astuto

  2. MUHC Montreal Children’s Hosp, McGill Un, Department of Anesthesia, Montreal, Canada

    Pablo M Ingelmo

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Pirotte, T. (2016). Vascular Access in the Perioperative Period. In: Astuto, M., Ingelmo, P. (eds) Perioperative Medicine in Pediatric Anesthesia. Anesthesia, Intensive Care and Pain in Neonates and Children. Springer, Cham. https://doi.org/10.1007/978-3-319-21960-8_19

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-21960-8_19

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-21959-2

  • Online ISBN: 978-3-319-21960-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation