Venous Access In Pediatric Anesthesia And Intensive Care

Abstract

Intravenous cannulation in pediatrics is one of the most commonlyperformed procedures in this age group. This procedure can be very challenging especially in small,dehydrated or obese children. This has led to adoption of variable techniques and aids to facilitatethe visualization of the veins that are invisible to the naked eye. Transillumination is one of these techniques. It is simple and can be used especially in neonates. Other advanced techniques include the use ofnear infrared light to visualize peripheral veins. However, when peripheral venous cannulation is difficult, time consuming ornot sufficient for certain critical conditions,other routes for venous access are available. This includes the intraosseous route which can be obtained much faster than central or peripheral linesbut limited to short term management. The venous cutdown also offers a reliable alternative to central venous lines. Also Umbilical vein catheterization may be a life-saving procedure in neonates who require vascular access and resuscitation. Central venous lines in pediatrics remains the most suitable for long term management,however it can be accompanied by serious complications. Infection, throbosis and even injury of nearby arteriesrepresent some of these serious complications. Alternatives to central venous lines include the peripherallyinserted central venous catheters (PICC) which are associated with muchless compliations than conventional central venous lines. The use of ultrasound in both peripheral and central venous cannulation attributed greatly to increasing the likelihood ofsuccessful cannulation and reduction of associated complications.