الفهرس 
Vascular access in cardiac catheterization inOnly 14 pages are availabe for public view
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Abstract
Vascular access in infants and children with multiple prior catheterizations can pose a significant challenge to the pediatric interventional cardiologist and may consume up to 25% of the entire procedure time. Guidance for vascular access is traditionally based on external anatomical landmarks, the technique of locating surface landmarks and palpation was used to assist in vascular access. Success in these procedures has relied upon a good working knowledge of vascular anatomy and identification of surface landmarks by visual inspection and palpation.
In the last 30 years, the US guided-technique starts to play important roles in vascular access. At first physicians stared to use audio Doppler which provided for more accurate guidance of the puncture procedure. Now the ultrasound procedure of choice is the two-dimensional ultrasound scan, or so-called B-scan. With color-Doppler imaging, irregular blood flow or differences in flow velocity can be measured. This can be helpful in determining the access site and in optimizing the exact localization of catheter placement.
The needle can be guided through the tissue directly or indirectly. In indirect ultrasound guidance, ultrasound scans are performed before puncture and needle insertion is without ultrasound. Direct ultrasound guidance visualizes the needle in real time, throughout the puncture process. The physician can visualize the vessels, check their patency, and carry out the puncture under direct vision.
Our study aimed to evaluate whether an ultrasound-guided technique can improve on the traditional landmark-guided technique in facilitating access to the femoral vein and in decreasing the complications in the pediatric cardiac catheterization laboratory.
In our study, we examined 60 patients with congenital heart disease; with age range from 3 days to 15years and weight range from 2,800 to 50 Kg. The patients were assigned to either ultrasound guided group (US) or landmark guided group (LM). In all patients vascular access was obtained through femoral vessels. Both LM and US groups were divided into 2 subgroups; femoral vein access subgroup, femoral vein and artery access subgroup.
In both LM-guided group and US-guided group detailed cardiac catheterization sheet was done. Color Doppler on femoral vessels was performed one day after catheterization to assess blood flow in femoral vessels, blood velocity in femoral artery and detect any complications such as DVT, arterial thrombosis, arteriovenous fistula and obstruction.
In each group, we compared rates of access to the femoral vein and femoral artery, procedure time, and incidence of complication in the two groups. In addition we compared groups to determine whether patient size or age affected the access rates and procedure time.
In summary, we found that there was non significant difference between US-guided technique and LM-guided technique in both access rate or procedure time in femoral vessels access.