Gaining vascular access in pediatric patients: Use of the PD Access Doppler needle

This article describes our initial experience with the P.D, Access Doppler needle for obtaining vascular access in pediatric patients. Patients were c onsidered for use of the P.D. Access Doppler needle (Escalon Vascular Acces s, New Berlin, WI) if they had a history of difficult access or body habitu s limitations to vascular access. An 18-, a 20-, or a 22-gauge bare needle with an inserted Doppler stylet was utilized. The time from initial subcuta neous entry of the Doppler needle until wire placement into the vessel lume n was recorded. Initial attempts to cannulate were performed with standard Seldinger technique, If attempts with the standard technique were unsuccess ful, then P.D. Access was utilized. However, P.D. Access was used primarily in small children for internal jugular vein cannulation or in patients wit h coarctation who had absent/diminished femoral pulses. P.D. Access cannula tion was attempted 39 times (31 patients). Median age is 23 months (range, 1 day to 15 years). Median weight is 10.5 kg (range, 1.767 kg). These patie nts had a mean of two prior cardiac catheterizations and/or surgeries (rang e, 0-6 procedures). Use of P.D. Access resulted in successful cannulation i n 35/39 (90%) attempts. In successful outcomes, the time from initial subcu taneous entry to cannulation is 6.5 +/- 4.9 min, In unsuccessful outcomes, failure was due to prior hematoma formation, operator inexperience, or prio r vessel occlusion. Successful use of P.D. Access shortens the duration of vascular access in difficult pediatric patients. In our cardiac catheteriza tion laboratory, this technique has become the preferred initial entry tech nique for cannulation of the internal jugular vein in small children, In ad dition, this technique was particularly useful for femoral artery cannulati on in patients with coarctation of the aorta with absent/diminished femoral pulses. Cathet, Cardiovasc, Intervent 51:61-64, 2000. (C) 2000 Wiley-Liss, Inc.