Comparison of 3 Peripheral Vascular Access, Pediatric Anesthesia
Conditions
Keywords
Ultrasound guidance, Vascular access, Pediatric anesthesia
Brief summary
Landmarks used to make a vascular puncture has long been based on the only knowledge of anatomy. This method assumes that the target vessel is in its expected position, permeable (non-thrombosed), and heavy enough to be catheterized. Any variations from these assumptions is likely to cause failures of puncture and complications. The development of ultrasound allowed to see the structures to achieve, whether before a puncture or in live for guiding the procedure. Visualization of vessels and adjacent structures has logically resulted in larger cases to a greater security of catheterization, improving the success rate, and decreasing complications. Several positions of the probe can be used to guide a puncture under ultrasound: the transversal approach in short axis, the long axis longitudinal approach and the oblique view approach.The aim of the study was to compare these three different ultrasound-guided approaches to peripheral vascular access in children. All children weighing less than 30 kg that should benefit from the introduction of an arterial catheter or central venous catheter introduced through a peripheral vein are eligible. Patients will be included after parent's and children's information and consent. The choice of the technique used (transverse, longitudinal or oblique approach) is determined by a randomization table.The puncture procedure is performed according to the usual protocols of the paediatric anesthesia unit of the investigators, under ultrasound guidance in a sterile manner. No time limit is required for the identification and implementation of the catheter. The position of the probe is dictated by the result of randomization and the Seldinger technique is used for the establishment of the catheter. Beyond two unsuccessful attempts, the procedure is considered as a failure. The anesthetist then uses the alternative technique of his choice. All anesthetists participating in this study exercised their main activity in the Montpellier University Hospital pediatric anesthesia unit. The laying of ultrasound-guided peripherally inserted central catheter and arterial catheter is part of the current activity of the unit.
Interventions
OTHERUltrasound-guided approach to peripheral vascular access
the transversal approach is in short axis with an out of plane puncture, the longitudinal approach is in transversal axis with an in plane puncture, the oblique view approach is in obliques axis with an in plane puncture
Sponsors
University Hospital, Montpellier
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
No minimum to 18 Years
Healthy volunteers
No
Inclusion criteria
1. Child requiring the implementation of a peripherally inserted central catheter or an arterial catheter. 2. Child whose general state corresponds to the Physical status score I - IV 3. Child whose weight is lower to 30 kg 4. Child whose parents will have given their informed consent. 5. Child affiliated to a national insurance scheme
Exclusion criteria
1. Child presenting a contraindication to the general anesthesia 2. Child whose weight is upper to 30 kg 3. Child whose parents did not give their informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Success rate | one hour | The success of the procedure is defined by the success of the puncture to the first or the second attempt. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The duration of the puncture procedure | on hour | the duration of the puncture procedure is defined for the puncture until objectivization of a blood reflux. |
| The number of attempts | one hour | the number of attempts is defined by the number of puncture performed |
| The operator satisfaction | one hour | Level of satisfaction of the operators according to the technique used |
Countries
France
Outcome results
None listed