Catheter insertion with ultrasonography guide

Central venous catheter (CVC) placement is frequently required in the care of critically ill and injured children. Common indications for placement include reliable venous access for medication administration, monitoring of central venous pressure and central venous oxygen saturation, parenteral nutrition, and frequent blood sampling. CVCs are also placed for hemodialysis, hemofiltration, and apheresis in the PICU.Three sites are commonly used for paediatric CVC placement: femoral, internal jugular, and subclavian. Most CVCs are placed using the wire-guided (Seldinger) technique, in which a needle or catheter-over-needle unit is introduced into the desired vein, blood is aspirated, and a guide wire is placed through the needle or catheter. Early complications include perforations (vessels and other structures) that may be related to the needle, guidewire, dilator, or catheter, or later perforations related to catheter-induced erosion. There is great variability in human anatomy and it makes it difficult to cannulate the vein. Thus it is important to look with ultrasound before cannulation attempts to avoid puncture to the artery.Ultrasonography is used increasingly at the bedside to assist in the placement of CVCs. Ultrasound is recommended for routine use in CVC placement; reports demonstrate that its use reduces complications in infants and children. Multiple Research Studies demonstrate decreased number of puncture attemts and lower complication rate (PTX, Hematoma) with ultrasound guidance. Some operators use the technology to mark the vein prior to attempted puncture (static technique), while others use real-time imaging to guide the needle puncture and CVC placement (dynamic technique). Higher success rates are generally found when real-time images are obtained and used to guide needle and catheter insertion during the procedure.