Çiğdem YILDIRIM GÜÇLÜ, Gülnur GÖLLÜ, Başak Ceyda MEÇO, Gönül KÜÇÜK, Zekeriya ALANOĞLU, Hüseyin DİNDAR, NESLİHAN ALKIŞ

Ultrasonography for Pediatric Central Vein Catheterisation in Inexperienced Hands: A Preliminary Report

Objective: Central venous catheterization is a technically difficult procedure in pediatric patients. Ultrasound guidance is becoming popular during the procedure. This study is designed to examine the success rate of ultrasound guidance during internal jugular vein catheterization and factors influencing the success rate in pediatric patients. Methods: Pediatric patients who underwent central venous catheterization within a period of 12 months were included in the study. After routine anesthesia induction and treatment, patients were positioned for catheterization. Ultrasound-guided catheterization was performed. The performer specified the time to switch cutdown method for catheterization. The patients’ demographic characteristics, the performers’ experience, cannulation side, number of attempts and complications were recorded. Success was defined as accomplishment of ultrasound-guided catheterization. Results: In 144 out of 180 patients, cannulation was achieved at the first attempt. Only in 8 catheterization procedures, more than one performer tried to realize the intervention. Nine patients had cutdowns for cannulation, which meant that ultrasound guidance was successful in cannulation of 171 (95%) patients. Seven cutdowns were performed by the attending physicians, and the other two by residents. Complications as arterial puncture, hemothorax, and pneumothorax were not seen during catheterization. Conclusion: Ultrasonografi is a very useful tool for catheterization in pediatric patients even in inexperienced hands. Experience is an important factor for improving the success.

Ultrasonografi ile Deneyimsiz Ellerde Pediyatrik Santral Ven Kateterizasyonu: Ön Rapor

Amaç: Santral venöz kateterizasyon pediyatrik hastalarda teknik olarak zor bir işlemdir. İşlem sırasında ultrason rehberliği popüler hale gelmektedir. Bu çalışma, pediyatrik hastalarda internal juguler ven kateterizasyonu sırasında ultrason rehberliğinin başarı oranını ve başarı oranını etkileyen faktörleri incelemek için tasarlanmıştır. Yöntem: 12 ay boyunca santral kateter yerleştirilen pediyatrik hastalar dahil edildi. Rutin anestezi indüksiyonu ve tedavisinden sonra hastalara kateterizasyon için pozisyon verildi. Kateterizasyon ultrason rehberliğinde yapıldı. Ne zaman cut-down’a dönüleceğine kateteri takan kişi karar verdi. Hastaların demografik özellikleri, uygulayıcı deneyimi, kanülasyon tarafı, deneme sayısı ve komplikasyonlar kaydedildi. Başarı, ultrason rehberliği ile kateterizasyon olarak tanımlandı. Bulgular: İlk girişimde 180 hastanın 144’ünde kanülasyon yapıldı. Yalnızca 8 kateterizasyon işleminde, birden fazla kişi deneme yaptı. Dokuz hastada kanülasyon için cut-down kullanıldı, bu da ultrason rehberliğinin 171 (%95) hastanın kanülasyonunda başarılı olduğu anlamına geliyor. Dokuz cut-downın 7’si asistanlar, 2’si uzmanlar tarafından gerçekleştirildi. Kateterizasyon sırasında arteriyel ponksiyon, hemotoraks ve pnömotoraks gibi komplikasyon görülmedi. Sonuç: Ultrasonografi, deneyimsiz ellerde bile pediyatrik hastalarda kateterizasyon için çok yararlı bir araçtır. Deneyim, başarının iyileştirilmesinde önemli bir faktördür.

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