Can we give blood transfusion through an arterial femoral line?
I mean,can we give blood transfusion{packed red blood cells} through an arterial femoral line for the neonates?and why?
For neonates, the usual IV site created is the large veins in the head. My son was extremely premature and this was the only vein large enough to do transfusions and IV infusions.
Percutaneous peripheral catheters
In the acute setting, IV catheters are used for the delivery of resuscitative medications, antibiotics, and volume expanders. In the less dynamic scenario, they enable provision of maintenance fluids for patients unable to maintain adequate hydration or those restricted from oral intake. Peripheral venous catheters are the easiest and safest means of achieving vascular access. The use of tourniquets, heat lamps, and translumination devices helps to facilitate insertion.
Dorsal veins on the hands and feet are the preferred choice for location. Reserve larger veins, such as the median antecubital, basilic, and median cephalic veins, for peripheral venipuncture or peripheral intravenous central catheter (PICC) access or for later attempts if more distal sites fail. Lower extremity vessels appropriate for peripheral access include those of the dorsum of the feet and the saphenous veins at the ankle.
In neonates and younger infants, superficial scalp veins may be accessed, but use of these sites usually requires that the surrounding hair be shaved. Use caution to avoid inadvertently cannulating the temporal artery or one of its branches. Another site that is not generally used except in emergency situations is the femoral vein. Understanding of the anatomy of the femoral region is essential to avoid injury to the femoral nerve and artery. The external jugular vein is another useful site if other sites fail (see Image 1). The infant must often be immobilized and placed in a dependent posture for safe insertion. External jugular catheters are difficult to stabilize and are easily dislodged, thus care must be taken to adequately secure it once in place.
Whichever site is chosen, always anticipate the need for adequate restraint for all pediatric patients. Always make sure “your first shot is your best shot” and always use as much taping and immobilization of the extremity with an armboard as necessary to avoid its removal by the patient. A demonstrable flashback within the IV tubing may not occur in infants; do not assume that the absence of blood return indicates improper placement. Rather, flush the catheter and check for infiltrative swelling to measure successful cannulation. In neonates and infants, use a 22- or 24-gauge needle, whereas in older children, a 20-gauge needle can be tolerated.
Here is a site that discusses this more:
http://www.emedicine.com/ped/topic3050.htm
October 28th, 2009 at 8:07 am
neonates i don’t know but in adults you don’t blast stuff up an art line… you’re going against the blood pressure!
in a neonate it should be a piece of cake to get an umbilical CVC
References :
October 28th, 2009 at 8:20 am
For neonates, the usual IV site created is the large veins in the head. My son was extremely premature and this was the only vein large enough to do transfusions and IV infusions.
Percutaneous peripheral catheters
In the acute setting, IV catheters are used for the delivery of resuscitative medications, antibiotics, and volume expanders. In the less dynamic scenario, they enable provision of maintenance fluids for patients unable to maintain adequate hydration or those restricted from oral intake. Peripheral venous catheters are the easiest and safest means of achieving vascular access. The use of tourniquets, heat lamps, and translumination devices helps to facilitate insertion.
Dorsal veins on the hands and feet are the preferred choice for location. Reserve larger veins, such as the median antecubital, basilic, and median cephalic veins, for peripheral venipuncture or peripheral intravenous central catheter (PICC) access or for later attempts if more distal sites fail. Lower extremity vessels appropriate for peripheral access include those of the dorsum of the feet and the saphenous veins at the ankle.
In neonates and younger infants, superficial scalp veins may be accessed, but use of these sites usually requires that the surrounding hair be shaved. Use caution to avoid inadvertently cannulating the temporal artery or one of its branches. Another site that is not generally used except in emergency situations is the femoral vein. Understanding of the anatomy of the femoral region is essential to avoid injury to the femoral nerve and artery. The external jugular vein is another useful site if other sites fail (see Image 1). The infant must often be immobilized and placed in a dependent posture for safe insertion. External jugular catheters are difficult to stabilize and are easily dislodged, thus care must be taken to adequately secure it once in place.
Whichever site is chosen, always anticipate the need for adequate restraint for all pediatric patients. Always make sure “your first shot is your best shot” and always use as much taping and immobilization of the extremity with an armboard as necessary to avoid its removal by the patient. A demonstrable flashback within the IV tubing may not occur in infants; do not assume that the absence of blood return indicates improper placement. Rather, flush the catheter and check for infiltrative swelling to measure successful cannulation. In neonates and infants, use a 22- or 24-gauge needle, whereas in older children, a 20-gauge needle can be tolerated.
Here is a site that discusses this more:
http://www.emedicine.com/ped/topic3050.htm
References :