- Email: [email protected]
Literature Review: Online-article reviews
L I T E R A T U R E
R E V I E W
Gail Heckler, RN, BS
ONLINE-ARTICLE REVIEWS Vascular Access in Pediatric Resuscitation Pamela Bailey, MD Up To Date Patient Information [Web site] Available at: http://patients.uptodate.com/topic.asp?fil e=ped_res/2900 DOI: 10.2309/java.12-1-4 his article discusses techniques for achieving peripheral and central percutaneous access and venous cutdowns as well as how implementing and following protocol during pediatric resuscitation can limit the time spent in futile attempts to achieve peripheral and central venous catheterization. This, in turn, saves lives. In this study, rapid, sequential attempts at percutaneous femoral vein catheterization, saphenous vein cutdown, and intraosseous cannulation were initiated if initial peripheral intravenous (IV) insertion failed after 90 seconds. Utilization of all techniques according to the protocol significantly improved IV access time. Intraosseous cannulation had a high degree of success when other measures failed. During a cardiopulmonary resuscitation, the preferred venous access site is the largest, most accessible vein that does not require the interruption of resuscitation. Peripheral veins should be attempted prior to other forms of vascular access, particularly if the peripheral veins can be readily
T
Correspondence concerning this article should be addressed to [email protected]
14
|
JAVA
|
Vol 12 No 1
seen or palpated. Attempts at peripheral and central venous access in the head, neck, and chest should be limited or avoided if possible to avoid interruption of ventilation and chest compressions. Intraosseous cannulation and peripheral venous access should be pursued simultaneously during cardiopulmonary resuscitation (CPR) and/or the treatment of severe shock. The author mentions that the most appropriate size of catheter for newborns and infants is a 22- or 24-gauge catheter and an 18- or 20-gauge for older children during resuscitation with peripheral IV insertion. The size of the cannula used in resuscitation should be the largest that can be inserted reliably. Butterfly needles should be avoided because they infiltrate easily. Excellent sites for peripheral IV access in the pediatric populations’ upper extremities are cephalic, basilic, and median cubital veins in the forearm and the dorsal veins of the hand. External jugular veins are an excellent choice. The great saphenous vein at the ankle is the most accessible vein in the lower extremities because of its large size and consistent anatomy. The veins of the dorsal arch can also be used. Scalp veins can be used, but are less desirable in urgent situations: The scalp may have to be shaved. The veins in the head can be cannulated by applying a circumferential tourniquet, such as a rubberband around the forehead. Caution must be used when accessing these veins because the temporal artery can be inadvertently cannulated. Cannulation of an artery is indicated by blanching of the proximal scalp when the flush is introduced. The central veins of choice discussed are the internal jugular, femoral, and subclavian veins. The femoral vein is the site
|
2007
used most frequently by pediatric emergency physicians due to relatively easy access; it is distant from the major sites of activity during resuscitation and is associated with a lower rate of complications compared with other sites. I found this to be applicable reading for all who work in emergency care and pediatric departments within the health care setting. The author discusses specific cannulation techniques in great detail as well as the advantages and disadvantages of each vein used in the study during pediatric resuscitation. Pathogenesis of and Risk Factors for Central Venous Catheter-Related Infections Svetlana Aminova, MD, and Jeffery D. Band, MD Up To Date Patient Information [Web site] Available at: http://patients.uptodate.com/topic.asp? file=hosp_inf/6194 and Central Venous Catheter-Related Infections: Types of Devices and Definitions Jeffery D. Band, MD Up To Date Patient Information [Web site] Available at: http://patients.uptodate.com/topic.asp? file=hosp_inf/8074 DOI: 10.2309/java.12-1-5 atheter-related bloodstream infections (CRBSIs) have been an increasing topic of discussion within the health care setting over the past
C
R E V I E W
Gail Heckler, RN, BS
ONLINE-ARTICLE REVIEWS Vascular Access in Pediatric Resuscitation Pamela Bailey, MD Up To Date Patient Information [Web site] Available at: http://patients.uptodate.com/topic.asp?fil e=ped_res/2900 DOI: 10.2309/java.12-1-4 his article discusses techniques for achieving peripheral and central percutaneous access and venous cutdowns as well as how implementing and following protocol during pediatric resuscitation can limit the time spent in futile attempts to achieve peripheral and central venous catheterization. This, in turn, saves lives. In this study, rapid, sequential attempts at percutaneous femoral vein catheterization, saphenous vein cutdown, and intraosseous cannulation were initiated if initial peripheral intravenous (IV) insertion failed after 90 seconds. Utilization of all techniques according to the protocol significantly improved IV access time. Intraosseous cannulation had a high degree of success when other measures failed. During a cardiopulmonary resuscitation, the preferred venous access site is the largest, most accessible vein that does not require the interruption of resuscitation. Peripheral veins should be attempted prior to other forms of vascular access, particularly if the peripheral veins can be readily
T
Correspondence concerning this article should be addressed to [email protected]
14
|
JAVA
|
Vol 12 No 1
seen or palpated. Attempts at peripheral and central venous access in the head, neck, and chest should be limited or avoided if possible to avoid interruption of ventilation and chest compressions. Intraosseous cannulation and peripheral venous access should be pursued simultaneously during cardiopulmonary resuscitation (CPR) and/or the treatment of severe shock. The author mentions that the most appropriate size of catheter for newborns and infants is a 22- or 24-gauge catheter and an 18- or 20-gauge for older children during resuscitation with peripheral IV insertion. The size of the cannula used in resuscitation should be the largest that can be inserted reliably. Butterfly needles should be avoided because they infiltrate easily. Excellent sites for peripheral IV access in the pediatric populations’ upper extremities are cephalic, basilic, and median cubital veins in the forearm and the dorsal veins of the hand. External jugular veins are an excellent choice. The great saphenous vein at the ankle is the most accessible vein in the lower extremities because of its large size and consistent anatomy. The veins of the dorsal arch can also be used. Scalp veins can be used, but are less desirable in urgent situations: The scalp may have to be shaved. The veins in the head can be cannulated by applying a circumferential tourniquet, such as a rubberband around the forehead. Caution must be used when accessing these veins because the temporal artery can be inadvertently cannulated. Cannulation of an artery is indicated by blanching of the proximal scalp when the flush is introduced. The central veins of choice discussed are the internal jugular, femoral, and subclavian veins. The femoral vein is the site
|
2007
used most frequently by pediatric emergency physicians due to relatively easy access; it is distant from the major sites of activity during resuscitation and is associated with a lower rate of complications compared with other sites. I found this to be applicable reading for all who work in emergency care and pediatric departments within the health care setting. The author discusses specific cannulation techniques in great detail as well as the advantages and disadvantages of each vein used in the study during pediatric resuscitation. Pathogenesis of and Risk Factors for Central Venous Catheter-Related Infections Svetlana Aminova, MD, and Jeffery D. Band, MD Up To Date Patient Information [Web site] Available at: http://patients.uptodate.com/topic.asp? file=hosp_inf/6194 and Central Venous Catheter-Related Infections: Types of Devices and Definitions Jeffery D. Band, MD Up To Date Patient Information [Web site] Available at: http://patients.uptodate.com/topic.asp? file=hosp_inf/8074 DOI: 10.2309/java.12-1-5 atheter-related bloodstream infections (CRBSIs) have been an increasing topic of discussion within the health care setting over the past
C