Preliminary experience with the Doppler ultrasound guided vascular access needle in paediatric patients

Abstract

Percutaneous cannulation of the internal jugular vein (IJV) in infants and children may be technically difficult and can lead to complications. Various techniques exist to achieve successful cannulation and to reduce the rate of complications. We report the use of the Doppler ultrasound guided vascular access needle (the SMART needle) for IJV cannulation in 10 infants and young children (mean age 3.7 months) weighing less than 10 kg (mean weight 5.5 kg) who were to undergo cardiac surgery at Great Ormond Street Hospital for Children. Successful cannulation was achieved in six out of 10 patients with haematoma complicating the procedure in two patients. We believe this is the first reported use of this device for cannulation of the IJV in this patient group.

Puncture of the popliteal artery using a Doppler-equipped (SMART) needle in transpopliteal interventions

“…The complication rate of 5.2% in our study is comparable with prior studies [2,4,5,6,13], where complication rates of 4-14% are reported. The rate of AV fistulas in our study (2 of 115, 1.7%) is lower than that reported in other studies (6-14%) [2,6,16], whereas fistulas were not seen in older reports of the fluoroscopy technique [3,5]. Although all patients were controlled immediately as well as 24 h after the intervention clinically and by auscultation, color-coded ultrasound was only performed if the former examinations led to the suspicion of AV fistula; therefore, it cannot be excluded that clinically inapparent AV fistula had been overlooked.…”

“…In this study, results in terms of complication rate and technical success did not benefit significantly from the use of the SMART needle, but aberrant punctures could be avoided. Subsequent studies evaluated the use of the SMART needle for punctures of the femoral artery [15] or for arterial access in pediatric patients [16]. The use of this device facilitated required puncture and subjectively eased the vascular access.…”

“…The use of the Doppler needle has to be compared with other methods for the localization of the popliteal artery. Both fluoroscopic localization [2,3,5,6] and percutaneous Doppler sonography are well established [2,4,16]. While fluoroscopy allows the real-time visualization of popliteal artery, vein, and needle, it requires a second vascular access in the groin.…”

Massive blood transfusion in choroid plexus tumor surgery: 10-years' experience

“…Central catheter placement in high-risk surgical infants is increasing [7], not only in cardiovascular surgery [8][9][10] but also in pediatric neurosurgery [11,12]. Ultrasound guidance has significantly increased success rates by decreasing complications [9,13].…”

Doppler ultrasound guided vascular access needle in paediatric patients

“…S IR — Dr MacIntyre and colleagues are to be congratulated on their work with this novel technique (1); however, we feel that some points should be raised.…”