Pediatrik Acilde Girişimler: Damar Yolu, Entübasyon, Lomber Ponksiyon
Özet
Pediatrik hastalarda damar yolu, entübasyon ve lomber ponksiyon gibi girişimsel uygulamalar; tanı, tedavi ve resüsitasyon süreçlerinin etkinliğini doğrudan etkileyen, acil ve yoğun bakım ortamlarında sık karşılaşılan kritik müdahalelerdir. Çocuklarda küçük ve değişken anatomik yapılar ile sınırlı fizyolojik rezervler, bu girişimlerin erişkinlere göre daha dikkatli ve özgün yaklaşımlarla uygulanmasını gerektirir. Bu nedenle, yaşa uygun ekipman seçimi, aseptik tekniklere uyum, anatomik varyasyonların dikkate alınması ve olası komplikasyonların önlenmesine yönelik stratejiler büyük önem taşır. Bu bölümde; pediatrik hastalarda damar yolu sağlanması (periferik, santral ve intraosseöz), entübasyon ve lomber ponksiyon uygulamaları güncel kılavuzlar ve klinik deneyim ışığında bütüncül bir yaklaşımla ele alınmıştır.
Referanslar
Managing Shock. In: Pediatric Advanced Life Support: Provider Manual, Chamedies L, Samson RA, Schexnayder SM, Hazinski MF (Eds), American Heart Association, Dallas 2016. p.83.
Naik VM, Shyam Prasad Mantha S, Rayani BK. Vascular access in children. Indian J Anaesth [Internet]. 2019 Sep 1 [cited 2025 Jun 9];63(9):737. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6761776/
Lau CSM, Chamberlain RS. Ultrasound-guided central venous catheter placement increases success rates in pediatric patients: A meta-analysis. Pediatr Res [Internet]. 2016 Aug 1 [cited 2025 Jun 9];80(2):178–84. Available from: https://pubmed.ncbi.nlm.nih.gov/27057741/
Anderson J, Leonard D, Braner DAV, Lai S, Tegtmeyer K. Umbilical Vascular Catheterization. New England Journal of Medicine [Internet]. 2008 Oct 9 [cited 2025 Jun 9];359(15):e18. Available from: https://pubmed.ncbi.nlm.nih.gov/18843120/
Atıcı, A. Çocuklarda İleri Yaşam Desteği Programı(ÇİLYAD) Uygulayıcı Kursu Kitabı (6). Mersin: Arzu Yuca, Can Matbaacılık. 2010; p. 61-67.
Şancı Y, Balcı S. Pediatrik Vasküler Erişim Uygulamalarında Güncel Yaklaşım: Damar Görüntüleme Tekniği. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 2020; 11(2):200-203. doi: 10.31067/0.2019.132.
Smith SR. Emergency and elective venous access in children. In: Torrey SB, Wiley JF II, editors. UpToDate. Waltham, MA: UpToDate Inc.; 2025 Mar 25 [updated 2025 Mar 25; cited 2025 Jun 23]. Available from: https://www.uptodate.com.
Paterson RS, Chopra V, Brown E, Kleidon TM, Cooke M, Rickard CM, et al. Selection and insertion of vascular access devices in pediatrics: A systematic review. Pediatrics [Internet]. 2020 Jun 1 [cited 2025 Jun 9];145(Suppl 3):S243–68. Available from: https://pubmed.ncbi.nlm.nih.gov/32482738/
Unbeck M, Förberg U, Ygge BM, Ehrenberg A, Petzold M. Peripheral venous catheter related complications are common among paediatric and neonatal patients. Acta Paediatrica, International Journal of Paediatrics [Internet]. 2015 Jun 1 [cited 2025 Jun 9];104(6):566–74. Available from: https://pubmed.ncbi.nlm.nih.gov/25655941/
American Academy of Pediatrics. Recognition and management of cardiac arrest. In: Pediatric Advanced Life Support Provider Manual, Chameides L, Samson RA, Schexnayder SM, Hazinski MF (Eds), American Heart Association, Dallas 2011. p.141.
Reproduced with permission from: Yen K, Riegert A, Gorelick MH. Derivation of the DIVA score: A clinical prediction rule for the identification of children with difficult intravenous access. Pediatr Emerg Care 2008; 24(3):143-7.
Derderian SC, Good R, Vuille-dit-Bille RN, Carpenter T, Bensard DD. Central venous lines in critically ill children: Thrombosis but not infection is site dependent. J Pediatr Surg [Internet]. 2019 Sep 1 [cited 2025 Jun 15];54(9):1740–3. Available from: https://pubmed.ncbi.nlm.nih.gov/30661643/
Reyes JA, Habash ML, Taylor RP. Femoral central venous catheters are not associated with higher rates of infection in the pediatric critical care population. Am J Infect Control [Internet]. 2012 Feb [cited 2025 Jun 15];40(1):43–7. Available from: https://pubmed.ncbi.nlm.nih.gov/21704431/
Tu S, Wang X, Bai L, Wang H, Ye M, Shi Y, et al. Complications of 1309 internal jugular vein cannulations with the anatomic landmarks technique in infants and children. Journal of Vascular Access [Internet]. 2012 [cited 2025 Jun 15];13(2):198–202. Available from: https://pubmed.ncbi.nlm.nih.gov/22020528/
Seldinger SI. Catheter replacement of the needle in percutaneous arteriography: A new technique. Acta radiol [Internet]. 1953 May 1 [cited 2025 Jun 9];39(5):368–76. Available from: https://pubmed.ncbi.nlm.nih.gov/13057644/
Tobias JD, Ross AK. Intraosseous infusions: A review for the anesthesiologist with a focus on pediatric use. Anesth Analg [Internet]. 2010 [cited 2025 Jun 15];110(2):391–401. Available from: https://pubmed.ncbi.nlm.nih.gov/19897801/
Luck RP, Haines C, Mull CC. Intraosseous access. Journal of Emergency Medicine [Internet]. 2010 Oct [cited 2025 Jun 15];39(4):468–75. Available from: https://pubmed.ncbi.nlm.nih.gov/19545966/
Orlowski JP. Emergency alternatives to intravenous access: Intraosseous, intratracheal, sublingual, and other-site drug administration. Pediatr Clin North Am [Internet]. 1994 [cited 2025 Jun 15];41(6):1183–99. Available from: https://pubmed.ncbi.nlm.nih.gov/7984381/
Capobianco S, Weiss M, Schraner T, Stimec J, Neuhaus K, Neuhaus D. Checking the basis of intraosseous access—Radiological study on tibial dimensions in the pediatric population. Paediatr Anaesth [Internet]. 2020 Oct 1 [cited 2025 Jun 15];30(10):1116–23. Available from: https://pubmed.ncbi.nlm.nih.gov/32720412/
Sagarin MJ, Chiang V, Sakles JC, Barton ED, Wolfe RE, Vissers RJ, et al. Rapid sequence intubation for pediatric emergency airway management. Pediatr Emerg Care [Internet]. 2002 Dec [cited 2025 Jun 15];18(6):417–23. Available from: https://pubmed.ncbi.nlm.nih.gov/12488834/
Losek JD, Olson LR, Dobson J V., Glaeser PW. Tracheal intubation practice and maintaining skill competency survey of pediatric emergency department medical directors. Pediatr Emerg Care [Internet]. 2008 May [cited 2025 Jun 15];24(5):294–9. Available from: https://pubmed.ncbi.nlm.nih.gov/18496112/
Capone CA, Emerson B, Sweberg T, Polikoff L, Turner DA, Adu-Darko M, et al. Intubation practice and outcomes among pediatric emergency departments: A report from National Emergency Airway Registry for Children (NEAR4KIDS). Academic Emergency Medicine [Internet]. 2022 Apr 1 [cited 2025 Jun 15];29(4):406–14. Available from: https://pubmed.ncbi.nlm.nih.gov/34923705/
Betül GÜLALP. Pediatrik Havayolu Yönetimi.Turkiye Klinikleri J Emerg MedSpecial Topics 2015 .
Khine HH, Corddry DH, Kettrick RG. Comparison of cuffed and uncuffed endotracheal tubes in young children during general anesthesia. Anesthesiology 1997;86(3) .
From Benumof JL, editor: Airway management: principles and practice, St. Louis, 1996, Mosby, p 263
.
Dr. A KAPLAN. Geleneksel laringoskopi ile video destekli laringoskopi yöntemlerinin, normal ve zor havayolu simülasyon maketinde karşılaştırılması. Uzmanlık Tezi,2016.
Wiley JF, Cronin KM. Lumbar puncture. In: Textbook of Pediatric Emergency Medicine Procedures, 2nd edition, King C, Henretig FM (Eds), Wolters Kluwer | Lippincott Williams & Wilkins, Philadelphia 2007.
Kneen R, Michael BD, Menson E, Mehta B, Easton A, Hemingway C, et al. Management of suspected viral encephalitis in children - Association of British Neurologists and British Paediatric Allergy, Immunology and Infection Group National Guidelines. Journal of Infection [Internet]. 2012 May [cited 2025 Jun 15];64(5):449–77. Available from: https://pubmed.ncbi.nlm.nih.gov/22120594/
Da Silva PSL, De Souza Loduca RD. Intramedullary spinal cord abscess as complication of lumbar puncture: A case-based update. Child’s Nervous System [Internet]. 2013 Jul [cited 2025 Jun 15];29(7):1061–8. Available from: https://pubmed.ncbi.nlm.nih.gov/23559394/
Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, et al. Practice guidelines for the management of bacterial meningitis. Clinical Infectious Diseases [Internet]. 2004 Nov 1 [cited 2025 Jun 15];39(9):1267–84. Available from: https://pubmed.ncbi.nlm.nih.gov/15494903/
Dreisinger N, Zapolsky N. Complexities of Consent: Ethics in the Pediatric Emergency Department. Pediatr Emerg Care [Internet]. 2018 Apr 1 [cited 2025 Jun 15];34(4):288–90. Available from: https://pubmed.ncbi.nlm.nih.gov/28419019/
Baxter AL, Welch JC, Burke BL, Isaacman DJ. Pain, position, and stylet styles: Infant lumbar puncture practices of pediatric emergency attending physicians. Pediatr Emerg Care [Internet]. 2004 Dec [cited 2025 Jun 15];20(12):816–20. Available from: https://pubmed.ncbi.nlm.nih.gov/15572969/