The Michigan Appropriateness Guide for Intravenous Catheters in children with congenital heart disease: miniMAGIC-CHD

Abstract

Background: The approach to vascular access in children with CHD is a complex decision-making process that may have long-term implications. To date, evidence-based recommendations have not been established to inform this process. Methods: The RAND/UCLA Appropriateness Method was used to develop miniMAGIC, including sequential phases: definition of scope and key terms; information synthesis and literature review; expert multidisciplinary panel selection and engagement; case scenario development; and appropriateness ratings by expert panel via two rounds. Specific recommendations were made for children with CHD. Results: Recommendations were established for the appropriateness of the selection, characteristics, and insertion technique of intravenous catheters in children with CHD with both univentricular and biventricular physiology. Conclusion: miniMAGIC-CHD provides evidence-based criteria for intravenous catheter selection for children with CHD.

Real-Time Ultrasound Guidance for Umbilical Venous Cannulation in Neonates With Congenital Heart Disease

“…Thrombosis of these vessels may preclude life-saving interventions, including extracorporeal membrane oxygenation cannulation and cardiac catheterization. Most importantly in this population, patency of the superior vena cava and inferior vena cava (IVC) is essential to the successful staged palliation of single-ventricle CHD (8).…”

“…Umbilical venous catheter (UVC) insertion is the preferred vascular access approach in many cardiac centers, as it spares the aforementioned vessels (8, 9). Successful UVC placement requires passing a catheter through the umbilical vein to the portal sinus (also called the umbilical recess), then through a patent ductus venosus (DV) to the subdiaphragmatic vestibule and inferior cavoatrial junction (Fig.…”