ABSTRACT
Safely obtaining vascular access in the pediatric population is challenging. This report highlights our real-world experience in developing a safer approach to obtaining vascular access using ultrasound guidance in children and infants with congenital heart disease. As part of a quality initiative, we prospectively monitored outcomes of all vascular access attempts guided by ultrasound from January 2010 to September 2010. Variables monitored included age, weight, the time from first needle puncture to wire insertion, site of insertion, number of attempts, type of line, and complications. There were 77 attempts [15 arterial and 62 venous] to obtain vascular access in 43 patients. The mean age was 15 months [6 days-11 years; median 2.5 months]. The mean weight was 7.2 kg [2-46 kg, median 3.8]. Success rates were 93% and 95% for arterial and venous cannulation, respectively. Mean time from first needle puncture to wire insertion was 3.9 min [0.5-15 min, median 2 min]. Fifty-five [75%] central line cannulations were successful from the first puncture; 17[23%] were successful from the second puncture; and one case [2%] required three punctures. Thirty patients [45%] weighed less than 3.5 kg. This lower body weight did not affect success rate, which was unexpectedly high [96.6%]. There were no associated complications. Ultrasound guided vascular cannulation in critically ill pediatric patients is safe, effective and efficient. This approach had a high success rate, and was associated with zero complications in our setting
ABSTRACT
Introduction: Infants with low body weight [LBW] following cardiac surgery are a major challenge for the post cardiac surgery care unit. It has been observed that post surgery outcome for LBW infants is worse compared to the outcome of normal body weight infants
A study was conducted to compare post operative course and outcome of infants with body weight of 2.2 kg or less against infants with normal body weight who underwent similar cardiac surgeries
Methods: A retrospective review was performed for all infants below 2.2 kg who underwent cardiac operations at King Abdulaziz Cardiac Center from January 2001 to October 2011. Cases with LBW [Group A] were compared with matching group [Group B] of normal body weight infants who had similar cardiac surgeries and matching surgical risk category. The demographic, ICU parameters, complications, and short-term outcome of both groups were analyzed
Results: Two groups were formed, with 37 patients in Group A, and 39 patients in Group B. Except for weight [2.13 +/- 0.08 kg in Group A vs 3.17 +/- 0.2 kg in Group B], there was no statistical difference in demographic data between both groups. Cardiac procedures included coarctation repair, arterial switch, ventricular septal defect [VSD] repair, tetralogy of Fallot repair, systemic to pulmonary shunt and Norwood procedures. Patients in Group A had statistically significant difference from Group B in terms of bypass time [p = 0.01], duration of inotropes [p = 0.01], duration of mechanical ventilation [p = 0.004], number of re-intubations [p = 0.015], PCICU length of stay [p = 0.007] and hospital mortality: 13.5% in Group A vs 0% in Group B [p value 0.02]
Conclusion: Patients with LBW [<2.2 kg] underwent cardiac surgery with overall satisfactory results, but with increased risk of ICU morbidity and mortality