Real-Time Ultrasound-Guided Peripheral Vascular Access in Pediatric Patients

To the Editor Peripheral vascular access in the pediatric patient can be difficult. Over a 13-month period, I began using ultrasound (US) to facilitate peripheral vascular access in our pediatric patients undergoing procedures and surgery in our operating rooms. A SonoSite MicroMaxx with a 6- to 13-MHz “hockey stick” probe (SonoSite, Bothell, WA) was used for peripheral access when routine cannulation attempts failed or patients were known to have difficult vascular access. The results are divided into 2 groups (Table 1). Group I patients are those for whom I was consulted (or 3 in whom I had difficulty myself) when peripheral vascular access was not obtained after multiple attempts. Group II were patients in whom vascular access was known either by record or parent report to be difficult, or children with no obvious access determined by inability to palpate a peripheral pulse or visualize or palpate a vein. There were 181 successful peripheral catheter insertions in 126 patients (vascular access was unsuccessful in 1 neonate patient after 3 attempts and a central venous catheter was placed by the surgeon), with an average of fewer than 1.16 skin punctures per obtained access. This represents an 85.78% first attempt success rate in patients in whom venous-arterial access was determined to be extremely difficult by the primary anesthesiologist. US-guided placement averaged between 2 and 3 minutes including preparation and securing of the catheters. Time was recorded in minutes by the anesthesia provider (certified registered nurse anesthetist, student registered nurse anesthetist, or anesthesia resident). Patients’ demographics were quite varied, and successful venous cannulation was predominantly in the left forearm cephalic vein. US-guided peripheral vascular access can be a significant benefit to patients and has been used with success in the adult and pediatric population1–6 with minimal data provided in pediatrics. Reducing the number of skin punctures may reduce puncture-related pain and infection risk. Although US-assisted venous cannulation is used routinely for central line placement, it is less frequently used for peripheral venous cannulation. My experience suggests that the US-assisted cannulation saves operating room time in the difficult access scenario and can in fact circumvent this very scenario when chosen as a primary method after adequate patient evaluation.7 Steven William Samoya, MD Pediatric Anesthesiology Monroe Carell Children’s Hospital at Vanderbilt Nashville, Tennessee [email protected]