The journal of vascular access
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Successful intravenous catheter placement plays a vital role in the pediatric emergency department. We assessed pediatric emergency department-related factors associated with difficult intravenous catheter placement. ⋯ The success rate of intravenous catheter placement at the pediatric emergency department could be improved by experienced providers. The acuity of disease and crowdedness at the pediatric emergency department were not significantly associated factors.
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Randomized Controlled Trial Comparative Study
Sonographic visualization and cannulation of the axillary vein in two arm positions during mechanical ventilation: A randomized trial.
Abduction of the arm has been used for ultrasound-guided infraclavicular axillary vein cannulation. We evaluated the influence of arm position on sonographic visualization and cannulation of the axillary vein in patients receiving mechanical ventilation. ⋯ Abducted position moved the clavicle cephalad and allowed sonographic visualization of infraclavicular axillary vein approximately 2 cm more proximally than with the adducted arm, with a comparable rate of cannulation success.
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Central venous catheterization of children is often a challenging procedure due to small anatomical structures. Ultrasound guidance has been shown to reduce complications and improve cannulation success as compared with the landmark-based technique. In-plane techniques allow for longitudinal visualization of the vessels and real-time visualization of needle track during its advancement. ⋯ A syringe-free and in-plane technique is used to cannulate the patients. The subclavian, jugular, and the brachiocephalic veins were visualized by endocavity micro-convex ultrasound probe as a Y shape during the cannulation procedure. We present a case series of successful cannulation by using this technique.
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Peripherally inserted central catheter tip migration is an infrequent event that occurs in neonatal, pediatric, and adult patients. We discuss a novel technique of utilizing intracavitary electrocardiogram to help confirm proper peripherally inserted central catheter tip repositioning, thereby reducing the need for serial radiographs. ⋯ Several techniques have been published on methods to reposition a migrated peripherally inserted central catheter tip back to the superior vena cava/right atrial junction. These repositioning techniques often require fluoroscopic guidance or a confirmatory radiograph to assess the appropriate peripherally inserted central catheter tip location. At times, several radiographs may be required before the tip is successfully repositioned. This novel application of intracavitary electrocardiogram can help to minimize radiographs when peripherally inserted central catheter tip repositioning is required.
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Randomized Controlled Trial
Ultrasound-guided central venous vascular access-novel needle navigation technology compared with conventional method: A randomized study.
Central venous catheter insertion is a common procedure in the intensive care setting. However, complications persist despite real-time ultrasound guidance. Recent innovation in needle navigation technology using guided positioning system enables the clinician to visualize the needle's real-time position and trajectory as it approaches the target. We hypothesized that the guided positioning system would improve performance time in central venous catheter insertion. ⋯ Ultrasound-guided central venous catheter insertion via internal jugular vein was a safe procedure in both conventional and guided positioning system methods. The guided positioning system did not confer additional benefit but was associated with slower performance time and lower satisfaction level among the experienced operators.