Ultrasound-guided peripheral vascular catheterization in pediatric patients: a narrative review
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ABSTRACT:
SUBMITTER: Nakayama Y
PROVIDER: S-EPMC7526377 | biostudies-literature | 2020 Jan
REPOSITORIES: biostudies-literature
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Project description:Central venous catheterization (CVC) is a frequent procedure, practiced by intensivists, anesthesiologists and advanced practice nurses in intensive care units and operative rooms. To reduce CVC-associated morbidity, it is essential to strive for best practices, based on the latest evidence. This narrative review aims to synthesize current knowledge on evidence-based best practices for CVC that improve the use and feasibility of real-time ultrasound-guided insertion procedures. Optimization of the vein puncture technique and the development of new technologies are discussed to reinforce the use of the subclavian vein catheterization as first choice. The search for alternative site of insertions, without increasing infectious and thrombotic risks, deserves further research.
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Project description:Lung diseases are the most common conditions in newborns, infants, and children and are also the primary cause of death in children younger than 5 years old. Traditionally, the lung was not thought to be a target for an ultrasound due to its inability to penetrate the gas-filled anatomical structures. With the deepening of knowledge on ultrasound in recent years, it is now known that the affected lung produces ultrasound artifacts resulting from the abnormal tissue/gas/tissue interface when ultrasound sound waves penetrate lung tissue. Over the years, the application of lung ultrasound (LUS) has changed and its main indications in the pediatric population have expanded. This review analyzed the studies on lung ultrasound in pediatrics, published from 2010 to 2020, with the aim of highlighting the usefulness of LUS in pediatrics. It also described the normal and abnormal appearances of the pediatric lung on ultrasound as well as the benefits, limitations, and possible future challenges of this modality.
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Project description:The presence of Internal Jugular Valves can pose a diagnostic and procedural challenge during ultrasound-guided cannulation. After ruling out dissection, thrombus, or ultrasound artifacts, it can still be accessed and successfully cannulated with appropriate precautions including use of Live ultrasound, positioning, use of soft-tipped catheters, and minimizing duration of catheter placement.
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Project description:BACKGROUND:The use of an ultrasound-guided technique for radial arterial catheterization has not been well established in pediatric patients. We conducted a systematic review and meta-analysis to evaluate the efficacy of the ultrasound-guided technique for radial artery catheterization in pediatric populations. METHOD:A systematic review of PubMed, Medline, Embase, and the Cochrane library was performed from their date of inception to December 2019. In this meta-analysis, we conducted online searches using the search terms "ultrasonography," "ultrasonics," "ultrasound-guided," "ultrasound," "radial artery," "radial arterial," "catheter," "cannula," and "catheterization." The rate of the first-attempt and total success, mean attempts to success, mean time to success, and incidence of complications (hematomas) were extracted. Data analysis was performed with RevMan 5.3.5. RESULTS:From 7 relevant studies, 558 radial artery catheterizations were enrolled, including 274 ultrasound-guided and 284 palpation catheterizations. The ultrasound-guided technique could significantly improve the rate of first-attempt and total success (RR 1.78, 95% CI 1.46 to 2.18, P?<?0.00001; RR 1.33; 95% CI 1.20 to 1.48; P?<?0.00001). However, there was significant heterogeneity for the total success rate among the included studies (I2 =?67%). The ultrasound-guided radial artery catheterization was also associated with less mean attempts and mean time to success (WMD -?1.13, 95% CI -?1.58 to -?0.69; WMD -?72.97?s, 95% CI -?134.41 to -?11.52) and lower incidence of the hematomas (RR 0.17, 95% CI 0.07 to 0.41). CONCLUSIONS:The use of the ultrasound-guided technique could improve the success rate of radial arterial catheterization and reduce the incidence of hematomas in pediatric patients. However, the results should be interpreted cautiously due to the heterogeneity among the studies.
| S-EPMC7201726 | biostudies-literature
Project description:Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) has revolutionized the diagnosis and staging of lung cancer. Multiple studies support EBUS as a safe, cost-effective, and accurate method of diagnosing lung cancer. Even with the groundbreaking developments of immunotherapy and targeted therapy in advanced non-small cell lung cancer, EBUS-TBNA remains the optimal method for obtaining tissue for molecular testing. Since the advent of EBUS, there have been a multitude of needles and biopsy tools that have been developed, each with its own unique features that may make it suitable for various clinical situations. With needle sizes ranging from 19 gauge to 25 gauge, and both aspiration and biopsy needles, as well as mini-forceps available, there are now numerous tools to choose from. Over the past several years, EBUS has also gained new roles outside the realm of lung malignancy. EBUS now plays an important role in diagnosing other thoracic pathology, such as sarcoidosis and lymphoma, as well as facilitating treatment of both benign and malignant disease. As the use of EBUS has become more widespread, new tools have emerged to allow for EBUS to continue expanding its applicability. This review examines the evidence for the current equipment and novel tools that are being used in EBUS-guided biopsy.
| S-EPMC8794368 | biostudies-literature
Project description:BackgroundPeripheral intravenous catheterization in children is challenging, and success rates vary greatly. We conducted a pragmatic randomized controlled trial to determine whether the use of ultrasound or near-infrared vascular imaging to guide catheterization would be more effective than the standard approach in achieving successful catheter placement on the first attempt.MethodsWe enrolled a convenience sample of 418 children in a pediatric emergency department who required peripheral intravenous catheterization between June 2010 to August 2012. We stratified them by age (≤ 3 yr and > 3 yr) and randomly assigned them to undergo the procedure with the standard approach, or with the help of either ultrasound or near-infrared vascular imaging. The primary outcome was the proportion of patients who had successful placement of a catheter on the first attempt.ResultsThe rate of successful first attempts did not differ significantly between either of the 2 intervention groups and the standard approach group (differences in proportions -3.9%, 95% confidence interval [CI] -14.2% to 6.5%, for ultrasound imaging; -8.7%, 95% CI -19.4% to 1.9%, for near-infrared imaging). Among children 3 years and younger, the difference in success rates relative to standard care was also not significant for ultrasound imaging (-9.6%, 95% CI -29.8% to 10.6%), but it was significantly worse for near-infrared imaging (-20.1%, 95% CI -40.1% to -0.2%). Among children older than 3 years, the differences in success rates relative to standard care were smaller but not significant (-2.3%, 95% CI -13.6% to 9.0%, for ultrasound imaging; -4.1%, 95% CI -15.7% to 7.5%, for near-infrared imaging). None of the pairwise comparisons were statistically significant in any of the outcomes.InterpretationNeither technology improved first-attempt success rates of peripheral intravenous catheterization in children, even in the younger group. These findings do not support investment in these technologies for routine peripheral intravenous catheterization in children.Trial registrationClinicalTrials.gov, no. NCT01133652.
| S-EPMC4435867 | biostudies-literature
Project description:BackgroundAxial facet joint interventions (e.g., medial branch block and radiofrequency ablation, facet joint intra-articular injection) are commonly performed for managing chronic spinal pain. Although traditionally performed with fluoroscopy or computed tomography (CT) guidance, ultrasound-guided techniques have also been developed for these interventions.AimsThe aim of this study is to present contemporary ultrasound-guided techniques for facet joint interventions and synthesize data addressing their accuracy, safety, and efficacy.MethodsThe PubMed, MEDLINE, CINAHL, Embase, and Cochrane Central Register of Controlled Trials databases were systematically searched for studies of ultrasound-guided facet joint interventions with human subjects from November 1, 1992, to November 1, 2022. Additional sources were drawn from reference lists and citations of relevant studies.ResultsWe found 48 studies assessing ultrasound-guided facet joint interventions. Ultrasound guidance for injection of the cervical facet joints and their innervating nerves had favorable accuracy (78%-100%), with lower procedural time compared to fluoroscopy or CT guidance and comparable pain relief. Accuracy with ultrasound-guided lumbar facet joint intra-articular injection (86%-100%) was more reliable than medial branch block (72%-97%); analgesia was comparable to fluoroscopy and CT guidance. In general, these procedures were more challenging for patients with obesity, and deeper structures were more difficult to accurately target (e.g., lower cervical levels, L5 dorsal ramus).ConclusionsUltrasound-guided facet joint interventions continue to evolve. Some technically challenging interventions may be impractical for widespread usage or require further technical refinement. The utility of ultrasound guidance with obesity and abnormal anatomy may be reduced.
| S-EPMC10193888 | biostudies-literature
Project description:IntroductionUltrasound guidance has emerged as an adjunct for central vein catheterization in both adults and children. However, the use of ultrasound guidance for radial arterial catheterization has not been well established. We conducted a systematic review and meta-analysis to evaluate the efficacy of ultrasound guidance for radial artery catheterization.MethodsPubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched. Randomized controlled trials (RCTs) comparing ultrasound guidance with other techniques (palpation or Doppler) in adult or pediatric patients requiring radial artery catheterization were included. The primary outcome was first-attempt success.ResultsSeven RCTs enrolling 546 patients met the inclusion criteria, and all the selected trials were considered as at high risk of bias. Ultrasound-guided radial artery catheterization was associated with an increased first-attempt success (relative risk (RR) 1.55, 95% confidence interval (CI) 1.02 to 2.35). There was significant heterogeneity among the studies (I2?=?74%). Ultrasound-guided radial artery catheterization in small children and infants also provided an increased chance for first-attempt success (RR 1.94, 95% CI 1.31 to 2.88). Ultrasound guidance further significantly reduced mean attempts to success (weighted mean difference (WMD) -1.13, 95% CI -1.58 to -0.69), mean time to success (WMD -72.97 seconds, 95% CI -134.41 to -11.52), and incidence of the complication of hematoma (RR 0.17, 95% CI 0.07 to 0.41).ConclusionsUltrasound guidance is an effective and safe technique for radial artery catheterization, even in small children and infants. However, the results should be interpreted cautiously due to the heterogeneity among the studies.
| S-EPMC4056628 | biostudies-literature
Project description:BackgroundUltrasound guided cannulation for peripheral venous insertion is a well-established methodology. However, there has never been a systematic review completed to synthesize evidence within the pediatric population. The current systematic review and meta-analysis was completed to compare the efficacy and safety profile of ultrasound guided peripheral cannulation against the conventional palpation technique within pediatric patients.MethodsA comprehensive search was conducted within the digital databases including Medline, EMBASE, ScienceDirect, Google Scholar and Cochrane library from inception until August 2021. A meta-analysis was then completed with random-effects model and reported pooled risk ratio (RR) or standardized mean difference (SMD) with 95% confidence interval (CI).ResultsIn total, 9 studies were analyzed, which included 1,312 participants, and the majority of studies (5 out 9 studies) were considered high quality. Amongst efficacy outcomes, first attempt success rate had a pooled RR of 1.53 (95% CI: 1.14-2.04), overall success rate had a pooled RR of 1.13 (95% CI: 1.01-1.26), number of attempts before successful cannulation had a pooled SMD of -1.93 [95%CI: -3.44 to -0.42], time taken for successful cannulation had a pooled SMD of -0.46 [95%CI: -1.20 to 0.28], needle redirections before successful cannulation had a pooled SMD of -1.26 [95%CI: -2.47 to -0.06]. Amongst safety outcomes, venous extravasation had a pooled RR of 1.59 (95% CI: 0.99-2.54) and phlebitis had an RR of 0.31 (95% CI: 0.07-1.50).ConclusionWithin pediatric patients, ultrasound guided peripheral venous cannulation is more efficacious when compared to the conventional palpation technique.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021275305, identifier: CRD42021275305.
| S-EPMC8859100 | biostudies-literature