|LETTER TO EDITOR
|Year : 2016 | Volume
| Issue : 1 | Page : 70-71
Guidewire replacement of leaking paediatric intravenous cannula
Parikshit Singh, Kunal Kishore
Department of Anaesthesiology and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
|Date of Web Publication||26-Jan-2016|
Department of Anaesthesiology and Critical Care, Armed Forces Medical College, Pune - 411 040, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh P, Kishore K. Guidewire replacement of leaking paediatric intravenous cannula. Indian J Anaesth 2016;60:70-1
An 18-month-old male child weighing 10 kg, a case of Holt Oram syndrome (congenital atrial septal defect, spontaneously closed at 10 months age, with a previously operated club hand deformity right side) was posted for the release of soft tissue right hand. The child's latest two-dimensional echocardiography showed no structural cardiac defect. The child was taken up for surgery under general anaesthesia.
Inhalational induction with sevoflurane was performed and a 22 gauge intravenous (IV) cannula was inserted into a vein at the dorsal aspect of the left hand. However, the cannula started to leak at the junction between the hub and the shaft [Figure 1]. The child's venous access was poor and any attempt to remove the catheter and look for a fresh IV access was abandoned. Instead, a 23 gauge arterial catheter (Leader-Cath ®) guidewire was inserted into the leaking IV catheter [Figure 2]. Thereafter, the culprit catheter was removed keeping the guidewire inside the precious vein. After this, a fresh 22 gauge IV cannula was reloaded over the guidewire into the vein thereby securing the IV line in this child.
|Figure 1: Black arrow depicting the site of leak in the 22 gauge intravenous catheter|
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Often anaesthesiologists encounter difficult venous access in the paediatric age group. Most of the veins in smaller children are difficult to gain access to. If, in this scenario, a precious IV access is at a risk of being lost due to unanticipated technical defects in the cannula itself it makes the task that much more difficult for the attending anaesthesiologist. The most common remedy resorted is removing the defective cannula and reinserting a new one at another site. This, however, may not always be easy. Central venous catheter (CVC) replacement over a guidewire has become an accepted technique for replacing a malfunctioning CVC. The insertion over a guidewire is associated with less discomfort and a significantly lower rate of mechanical complications than are those percutaneously inserted at a new site. In addition, this technique provides a means of preserving limited venous access in some patients. Although there are numerous articles referring to the change of central venous and intra-arterial catheters over a guidewire, no literature could be found reporting change of peripheral venous cannula over an arterial guidewire.
This case highlights the fact that simple innovative measures such as inserting an arterial guidewire into a leaking, but otherwise in-place, IV catheter and reloading a fresh catheter over it into the same peripheral vein can go a long way in preserving the venous access. This assumes significant importance in the paediatric population. It can also help by cutting down the time spent looking for a fresh IV access hence reducing the operating room time and resources.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]