Ultrasound-guided peripheral vascular catheterization in pediatric patients: a narrative review
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REVIEW
Open Access
Ultrasound-guided peripheral vascular catheterization in pediatric patients: a narrative review Yoshinobu Nakayama1,2*† , Jun Takeshita3†, Yasufumi Nakajima4,5† and Nobuaki Shime6†
Abstract Peripheral vascular catheterization (PVC) in pediatric patients is technically challenging. Ultrasound guidance has gained the most interest in perioperative and intensive care fields because it visualizes the exact location of small target vessels and is less invasive than other techniques. There have been a growing number of studies related to ultrasound guidance for PVC with or without difficult access in pediatric patients, and most findings have demonstrated its superiority to other techniques. There are various ultrasound guidance approaches, and a comprehensive understanding of the basics, operator experience, and selection of appropriate techniques is required for the successful utilization of this technique. This narrative review summarizes the literature regarding ultrasound-guided PVC principles, approaches, and pitfalls to improve its clinical performance in pediatric settings. Keywords: Ultrasound, Pediatrics, Peripheral catheterization, Blood vessels
Background Peripheral vascular catheterization (PVC) is an essential skill for perioperative, intensive, and emergency healthcare providers. In small children, operators often misjudge the exact location of vessels due to the presence of thick subcutaneous tissue and smaller vessel diameters, which in turn makes catheterization challenging. Currently, ultrasound guidance is an approach majorly used in such difficult cases. Numerous studies have demonstrated the utility of an ultrasound-guided approach in PVC in pediatric patients. Systematic reviews and meta-analyses have reported that ultrasound guidance improves pediatric PVC in terms of success rate, procedure time, number of * Correspondence: [email protected] † Yoshinobu Nakayama, Jun Takeshita, Yasufumi Nakajima and Nobuaki Shime contributed equally to this work. 1 Department of Anesthesiology and Critical Care, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan 2 Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, City College of New York, New York, USA Full list of author information is available at the end of the article
attempts, and number of complications [1–4]. Regarding infants and small children, ultrasound guidance increased the first-attempt rate, up to a relative risk of 2.2 in radial arterial catheterization, than the other techniques [3]. In neonates, it also improved first-attempt success rate, up to a relative risk of ~ 4.0 [5]. Thus, the utility of ultrasound guidance is considered higher in smaller children. However, ultrasound-guided PVC in smaller children remains challenging for less-experienced operators. The first-attempt success rate of ultrasound-guided radial arterial catheterization in pediatric patients was significantly increased than the palpation technique when performed by operators who were familiar with
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