Vascular access for bleeding surgery in a pediatric university hospital
Introdution and Objetives: The cannulation and vascular access in the child is essential for the infusion of fluids, drugs and blood components, to monitor cardiovascular function and for the extraction of blood samples. It presents greater difficulty in the infant and young children, requiring multiple attempts with the consequent increased risk of complications and loss of time before surgery. In the case of interventions at risk of developing massive hemorrhage, larger gages are required which further complicates the process.
Materials and Methods: A description of the clinical practice of the peripheral and central vascular accesses is more adequate for surgeries with risk of massive hemorrhage, analyzing the most suitable gauges, types of catheters and technique, as it is done in our institution, including limit situations such as liver transplantation where veins that drain into the inferior vena cava should not be channeled.
Discussion: Literature concerning catheterization of vascular access in children refers to situations in which only maintenance fluid is required. However, some situations (massive bleeding, transplants) require a different approach. Both access and caliber should be adapted to the patient´s age, type of surgery and clinical situation.
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The saphenous vein and the external jugular vein are useful as peripheral access in infants of difficult canalization. For the central compartment, ultrasound-guided technique is of choice. The right internal jugular vein is the most frequently channeled for situations with significant bleeding in our center. In situations of extreme urgency do not forget the intra-osseous access.
Conclusions: The vascular canalization in pediatrics requires a greater learning curve than in the adult, requiring knowledge of the technique and the appropriate material. The case of potential or actual situations of massive hemorrhage requires considering specific implications.