Ultrasound Guided Central Vascular Access in Neonates, Infants and Children

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Abstract:

Ultrasound guided central venous cannulation is rapidly becoming the standard technique for achieving a central line in neonates, infants and children. Older techniques such as surgical cutdown and ‘blind’ percutaneous venipuncture have many disadvantages: they are time consuming, vein consuming and/or associated with dangerous immediate or late complications. On the other hand, ultrasound has only advantages, giving the operator the possibility of (a) choosing the most appropriate and safest venous access on the basis of ultrasound assessment, (b) performing a 100% safe insertion, (c) ruling out malpositions or pleuro-pulmonary damages, during and after the procedure. Ultrasound guided central venous cannulation has been described in many clinical studies of the last decade, each one showing the higher efficacy and safety of ultrasound guidance in children when compared to the traditional landmark method. Ultrasound can be used for puncturing many different deep veins of the arm, neck, groin and thorax. The vein can be visualized either in short axis or in long axis, while the puncture can be performed ‘in-plane’ (when the needle trajectory is included in the plane of the ultrasound probe) or ‘out-of-plane’ (when the needle trajectory is not in that plane). Though, the best clinical results of ultrasound guidance can be achieved - particularly in neonates and infants - only if the operator has been properly trained in this technique through an appropriate curriculum that should include theory lessons, simulation practice and a tutored learning curve.

Keywords: Central lines; Central venous access; PICC; central venous catheters; long axis; neonates; short axis; ultrasound; ultrasound guidance; venipuncture

Document Type: Research Article

DOI: http://dx.doi.org/10.2174/138945012800675696

Affiliations: Department of Surgery, Catholic University, Largo Francesco Vito 1, 00168 Roma, Italy.

Publication date: June 1, 2012

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  • Current Drug Targets aims to cover the latest and most outstanding developments on the medicinal chemistry and pharmacology of molecular drug targets e.g. disease specific proteins, receptors, enzymes, genes. Each issue of the journal will be devoted to a single timely topic, with series of in-depth reviews, written by leaders in the field, covering a range of current topics on drug targets. These issues will be organized and led by a guest editor who is a recognized expert in the overall topic. As the discovery, identification, characterisation and validation of novel human drug targets for drug discovery continues to grow; this journal will be essential reading for all pharmaceutical scientists involved in drug discovery and development.
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