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Arterial catheterization in infants
626
Letters to the Editor
phils, as in our patient, is still an enigma. Eosinophilia has been described in several clinical syndromes, many of which may have an allergic etiology. Eosinophilia has been noted sporadically in patients with rheumatoid arthritis, a disease that has many immunologic features, a Corticosteroids may produce a rapid decrease in circulating eosinophils in patients with eosinophilia, but the drug shows no effect on eosinophils in vitro. It is often quite difficult to clearly separate eosinophilic leukemia from the other hypereosinophilic syndromes? Patients with eosinophilic leukemia may have marked elevation of the serum vitamin B12 level. 4
Carl Pochedly, M.D. Department o[ Pediatrics Nassau County Medical Center East Meadow, Long Island, N. Y. 11554 Thomas J. Degnan, M.D. Irving H. Mauss, M.D. Departments of Medicine and Pediatrics North Shore Hospital Manhasset, Long Island, N. Y. 11030 REFERENCES
1. Rickles F., and Miller, D.: Eosinophilic leukemoid reaction, J. P~mATR. 80" 418, 1972. 2. Roberts, M; H.: Extreme eosinophilia in childhood; report of 3 cases, South. Med. J. 47: 317, 1954. 3. Panush, R., Franco, A., and Schur, P.: Rheumatoid arthritis associated with eosinophilia, Ann. Intern. Med. 75" 199, 1971. 4. Fledelius, H.i Extreme persistent eosinophilia with high serum vitamin B12 values; a report of two cases, Acta Med. Scand. 187" 235, 1970.
Arterial catheterization in infants To the Editor: Retrograde arterial catheterization by the Seldinger technique is not considered as a routine procedure in infants because o f its attendant difficulties and risks. We believe that the difficulty of puncture is due chiefly to the Seldinger needles usually employed. Although there
The Journal of Pediatrics September 1972
are 19 T and 20 T sizes, these needles are not well adapted for use in infants' arteries. Their excessive length makes arterial puncture difficult; moreover, the artery is often extremely mobile in the loose soft tissues. Frequently the artery may be transfixed, inducing spasm and hematoma formation which make catheterization difficult and may lead to complications. We think that it is better to use a needle without a stylet, which permits the threading of guide wire of caliber 0.025 inches. We use a sharp pointed 18 gauge needle of the type normally employed for intravenous puncture, 4 cm. long and 1 mm. internal diameter. Puncture is usually easy, and the needle can be connected to a syringe so that penetration into the lumen of the artery is readily recognized and perforation of the posterior wall is avoided. The guide wire can then be introduced without difficulty; the subsequent examination is performed in the usual way. Using this technique with local anesthesia we have catheterized 17 infants, from birth to 2 years of age, of whom 9 were less than one year and 15 from 2 to 3 years of age. Of the infants, three weighed less than 5 Kg., and 12 weighed between 5 and 10 Kg. Most investigations were for congenital heart disease, but some Were for abdominal disease. In most instances the femoral artery was used but on three occasions the axillary artery was punctured: in one infant ten months and two 16 months of age. Catheterization of the axillary artery is useful if examination is likely to be prolonged or difficult (for instance, in aortic stenosis), because the risks of thrombosis are less. The axillary arterial approach is also recommended in patients with coarctation and in neuroradiologic procedures. So far we have had neither complications using this needle nor failures in attempted catheterizations.
M. Henry, M.D. J. C. Hoeffel, M.D. C. Pernot, M.D. Departments of Cardiology and Radiology University Hospital Jeanne d'Arc 54 Dommartin-Les-Toul, France
Letters to the Editor
phils, as in our patient, is still an enigma. Eosinophilia has been described in several clinical syndromes, many of which may have an allergic etiology. Eosinophilia has been noted sporadically in patients with rheumatoid arthritis, a disease that has many immunologic features, a Corticosteroids may produce a rapid decrease in circulating eosinophils in patients with eosinophilia, but the drug shows no effect on eosinophils in vitro. It is often quite difficult to clearly separate eosinophilic leukemia from the other hypereosinophilic syndromes? Patients with eosinophilic leukemia may have marked elevation of the serum vitamin B12 level. 4
Carl Pochedly, M.D. Department o[ Pediatrics Nassau County Medical Center East Meadow, Long Island, N. Y. 11554 Thomas J. Degnan, M.D. Irving H. Mauss, M.D. Departments of Medicine and Pediatrics North Shore Hospital Manhasset, Long Island, N. Y. 11030 REFERENCES
1. Rickles F., and Miller, D.: Eosinophilic leukemoid reaction, J. P~mATR. 80" 418, 1972. 2. Roberts, M; H.: Extreme eosinophilia in childhood; report of 3 cases, South. Med. J. 47: 317, 1954. 3. Panush, R., Franco, A., and Schur, P.: Rheumatoid arthritis associated with eosinophilia, Ann. Intern. Med. 75" 199, 1971. 4. Fledelius, H.i Extreme persistent eosinophilia with high serum vitamin B12 values; a report of two cases, Acta Med. Scand. 187" 235, 1970.
Arterial catheterization in infants To the Editor: Retrograde arterial catheterization by the Seldinger technique is not considered as a routine procedure in infants because o f its attendant difficulties and risks. We believe that the difficulty of puncture is due chiefly to the Seldinger needles usually employed. Although there
The Journal of Pediatrics September 1972
are 19 T and 20 T sizes, these needles are not well adapted for use in infants' arteries. Their excessive length makes arterial puncture difficult; moreover, the artery is often extremely mobile in the loose soft tissues. Frequently the artery may be transfixed, inducing spasm and hematoma formation which make catheterization difficult and may lead to complications. We think that it is better to use a needle without a stylet, which permits the threading of guide wire of caliber 0.025 inches. We use a sharp pointed 18 gauge needle of the type normally employed for intravenous puncture, 4 cm. long and 1 mm. internal diameter. Puncture is usually easy, and the needle can be connected to a syringe so that penetration into the lumen of the artery is readily recognized and perforation of the posterior wall is avoided. The guide wire can then be introduced without difficulty; the subsequent examination is performed in the usual way. Using this technique with local anesthesia we have catheterized 17 infants, from birth to 2 years of age, of whom 9 were less than one year and 15 from 2 to 3 years of age. Of the infants, three weighed less than 5 Kg., and 12 weighed between 5 and 10 Kg. Most investigations were for congenital heart disease, but some Were for abdominal disease. In most instances the femoral artery was used but on three occasions the axillary artery was punctured: in one infant ten months and two 16 months of age. Catheterization of the axillary artery is useful if examination is likely to be prolonged or difficult (for instance, in aortic stenosis), because the risks of thrombosis are less. The axillary arterial approach is also recommended in patients with coarctation and in neuroradiologic procedures. So far we have had neither complications using this needle nor failures in attempted catheterizations.
M. Henry, M.D. J. C. Hoeffel, M.D. C. Pernot, M.D. Departments of Cardiology and Radiology University Hospital Jeanne d'Arc 54 Dommartin-Les-Toul, France