Emergency Pediatric Vascular Access

2020 ◽  
pp. 568-573
Author(s):  
Garrett S. Pacheco
Keyword(s):  
Vascular Access ◽  
Emergency Physician ◽  
Pediatric Patients ◽  
Clinical Status ◽  
Medication Administration ◽  
Critical Conditions ◽  
Parental Preference ◽  
Small Vessels ◽  
Pediatric Emergencies ◽  
Needle Sticks

Vascular access is often needed for pediatric patients being treated in the emergency department. Access is often required to evaluate for acute metabolic emergencies, assess for infectious emergencies, to provide fluid resuscitation, blood product and medication administration. Obtaining vascular access can be a challenge, particularly in young children with small vessels and in critical conditions with dehydration or poor perfusion. The method, site, and size of device used to obtain vascular access primarily depend on the patient’s clinical status, the agent to be administered as well as parental preference. Anatomical differences considering the smaller vessels in pediatric patients and patient discomforts and fear of needle sticks afford challenges that are unique to this population. In addition, it is imperative that the emergency physician is cognizant and has strategies to treat both the child’s and the parent’s anxiety associated with the procedure. The emergency physician should have a level of comfort and knowledge of the various techniques and sites of access that are used for pediatric emergencies.

Therapeutic Plasma Exchange Application in Children Requires Individual Decision

2020 ◽  
Author(s):  
Gürkan Atay ◽  
Demet Demirkol
Keyword(s):  
Plasma Exchange ◽  
Vascular Access ◽  
Pediatric Patients ◽  
Demyelinating Disease ◽  
Pediatric Intensive Care ◽  
Therapeutic Plasma Exchange ◽  
Transplantation Rejection ◽  
Access Problems ◽  
Uremic Syndrome

AbstractTherapeutic plasma exchange (TPE) is a treatment administered with the aim of removing a pathogenic material or compound causing morbidity in a variety of neurologic, hematologic, renal, and autoimmune diseases. In this study, we aimed to assess the indications, efficacy, reliability, complications, and treatment response of pediatric patients for TPE. This retrospective study analyzed data from 39 patients aged from 0 to 18 years who underwent a total of 172 TPE sessions from January 2015 to April 2018 in a tertiary pediatric intensive care unit. Indications for TPE were, in order of frequency, macrophage activation syndrome (28.2%, n = 11), renal transplantation rejection (15.4%, n = 6), liver failure (15.4%, n = 6), Guillain–Barre's syndrome (15%, n = 6), hemolytic uremic syndrome (7.7%, n = 3), acute demyelinating disease (7.7%, n = 3), septic shock (5.1%, n = 2), and intoxication (5.1%, n = 2). No patient had any adverse event related to the TPE during the procedure. The TPE session was ended prematurely in one patient due to insufficient vascular access and lack of blood flow (2.6%). In the long term, thrombosis due to the indwelling central catheter occurred (5.1%, n = 2). TPE appears to be an effective first-stage or supplementary treatment in a variety of diseases, may be safely used in pediatric patients, and there are significant findings that its area of use will increase. In experienced hands and when assessed carefully, it appears that the rate of adverse reactions and vascular access problems may be low enough to be negligible.

scholarly journals Abstract No. 136 Evaluation of complications associated with tunneled vascular access lines in pediatric patients

2021 ◽  
Vol 32 (5) ◽  
pp. S60-S61
Author(s):  
D. Veyg ◽  
B. Reading ◽  
J. MacDonnell ◽  
N. Underwood ◽  
A. Robinson ◽  
...  
Keyword(s):  
Vascular Access ◽  
Pediatric Patients

Immersive technological approaches to managing perceived pain in pediatric patients undergoing vascular access procedures

2018 ◽  
Vol 19 (3) ◽  
pp. S34-S35
Author(s):  
O. Jang ◽  
A. Joseph ◽  
M. Hernandez ◽  
L. Simons ◽  
T. Caruso ◽  
...  
Keyword(s):  
Vascular Access ◽  
Pediatric Patients ◽  
Perceived Pain

Criterion and Construct Validity and Reliability of the Pediatric IV Difficulty Score

2020 ◽  
Author(s):  
Jane H. Hartman ◽  
James F. Bena ◽  
Shannon L. Morrison ◽  
Nancy M. Albert
Keyword(s):  
Construct Validity ◽  
Vascular Access ◽  
Pediatric Patients ◽  
Peripheral Vascular ◽  
Validity And Reliability ◽  
User Groups ◽  
Validity Criteria ◽  
Placement Success ◽  
Difficulty Score ◽  
Different Levels

Highlights Abstract Background: In pediatric patients, intravenous placement success may be related to predetermined vascular access difficulty. The study purpose was to examine validity and reliability of the 6-item Pediatric Intravenous Difficulty Score. Methods: We determined if a tool that assesses pediatric intravenous difficulty was associated with clinical outcomes of peripheral attempts (criterion validity), hypotheses regarding patients’ age, race, and medical diagnosis (construct validity), and reliability of difficulty levels. Results: In 596 episodes of peripheral intravenous attempts, first-attempt success, overall success, and number of staff attempting access were associated with level of intravenous access difficulty by tool score. The tool met hypothesized construct validity criteria, and in multivariable modeling, the tool was reliable based on difficulty levels of 2 user groups. Conclusions: The 6-item Pediatric Intravenous Difficulty Score has criterion and construct validity and is reliable over time among clinicians with different levels of expertise in peripheral vascular access.

Enteral and parenteral nutrition considerations in pediatric patients

2019 ◽  
Vol 76 (19) ◽  
pp. 1492-1510
Author(s):  
Mary Petrea Cober ◽  
Kathleen M Gura
Keyword(s):  
Best Practices ◽  
Parenteral Nutrition ◽  
Pediatric Patients ◽  
Medication Administration ◽  
Nutrition Support ◽  
Disease States ◽  
Pediatric Populations ◽  
Enteral And Parenteral Nutrition ◽  
Indications For Use ◽  
Selection Of

Abstract Purpose Current clinical practice guidelines on management of enteral nutrition (EN) and parenteral nutrition (PN) in pediatric patients are reviewed. Summary The provision of EN and PN in pediatric patients poses many unique considerations and challenges. Although indications for use of EN and PN are similar in adult and pediatric populations, recommended EN and PN practices differ for pediatric versus adult patients in areas such as selection of EN and PN formulations, timing of EN and PN initiation, advancement of nutrition support, and EN and PN goals. Additionally, provision of EN and PN to pediatric patients poses unique compounding and medication administration challenges. This article provides a review of current EN and PN best practices and special nutrition considerations for neonates, infants, and other pediatric patients. Conclusion The provision of EN and PN to pediatric patients presents many unique challenges. It is important for pharmacists to keep current with pediatric- and neonatal-specific guidelines on nutritional management of various disease states, as well as strategies to address compounding and medication administration challenges, in order to optimize EN and PN outcomes.

249 Distal Femur Site Is a Viable Option for IO Vascular Access in Pediatric Patients

2012 ◽  
Vol 60 (4) ◽  
pp. S90 ◽  
Author(s):  
E.J. Truemper ◽  
C.L. Beamer ◽  
L.J. Miller ◽  
D.F. Montez ◽  
T.A. Puga ◽  
...  
Keyword(s):  
Vascular Access ◽  
Pediatric Patients ◽  
Distal Femur ◽  
Viable Option

The Intranasal Route as an Alternative Method of Medication Administration

2018 ◽  
Vol 38 (5) ◽  
pp. 26-31 ◽  
Author(s):  
Calvin Tucker ◽  
Lyn Tucker ◽  
Kyle Brown
Keyword(s):  
Intranasal Administration ◽  
Pediatric Patients ◽  
Medication Administration ◽  
Intravenous Route ◽  
Appropriate Use ◽  
Intranasal Route ◽  
Superior Efficacy ◽  
Invasive Method ◽  
Correct Technique ◽  
Intranasal Drug Administration

Intranasal drug administration is a less invasive method of drug delivery that is easily accessible for adult and pediatric patients. Medications administered by the intranasal route have efficacy comparable to intravenous administration and typically have superior efficacy to subcutaneous or intramuscular routes. The intranasal route is beneficial in emergent situations when the intravenous route is not available. The intranasal route is safe and effective in various indications, and therapeutic systemic concentrations of medication can be attained via this route. As the evidence for and comfort with intranasal administration continue to grow, guidance on correct technique, medications, and dosing is vital for appropriate use. This article reviews the process and practices of appropriate intranasal medication administration.

scholarly journals Hemodialysis vascular access affects heart function and outcomes: Tips for choosing the right access for the individual patient

2020 ◽  
pp. 112972982096931
Author(s):  
Jan Malik ◽  
Carlo Lomonte ◽  
Joris Rotmans ◽  
Eva Chytilova ◽  
Ramon Roca-Tey ◽  
...  
Keyword(s):  
Heart Failure ◽  
Vascular Access ◽  
Heart Function ◽  
Clinical Status ◽  
Severe Heart Failure ◽  
Dialysis Patients ◽  
Av Fistula ◽  
Hemodialysis Vascular Access ◽  
Cardiovascular Morbidity And Mortality ◽  
The Individual

Chronic kidney disease is associated with increased cardiovascular morbidity and mortality. A well-functioning vascular access is associated with improved survival and among the available types of vascular access the arterio-venous (AV) fistula is the one associated with the best outcomes. However, AV access may affect heart function and, in some patients, could worsen the clinical status. This review article focuses on the specific cardiovascular hemodynamics of dialysis patients and how it is affected by the AV access; the effects of an excessive increase in AV access flow, leading to high-output heart failure; congestive heart failure in CKD patients and the contraindications to AV access; pulmonary hypertension. In severe heart failure, peritoneal dialysis (PD) might be the better choice for cardiac health, but if contraindicated suggestions for vascular access selection are provided based on the individual clinical presentation. Management of the AV access after kidney transplantation is also addressed, considering the cardiovascular benefit of AV access ligation compared to the advantage of having a functioning AVF as backup in case of allograft failure. In PD patients, who need to switch to hemodialysis, vascular access should be created timely. The influence of AV access in patients undergoing cardiac surgery for valvular or ischemic heart disease is also addressed. Cardiovascular implantable electronic devices are increasingly implanted in dialysis patients, but when doing so, the type and location of vascular access should be considered.

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