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  2. 2013
  3. December
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  5. Arterial line

Arterial line

ARTERIAL CANNULATIONS IN CHILDREN
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Exit Survey
 
 
Dear colleagues (en français plus bas),

You are invited to participate in our survey on arterial cannulation in children. In this survey, you will be asked about your experience, technics and rational for choosing/implementing arterial accesses in children. It will take approximately 10 minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in medical journals or conferences and will be anonymized. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact the people in charge by email at the email addresses specified below:

[email protected]
[email protected]
[email protected]

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.

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Chers Collègues,

Nous vous invitons à participer à notre enquête concernant les cannulations artérielles chez les enfants. Au cours du questionnaire, nous aimerions récolter votre expérience, vos techniques et votre algorithme décisionnel pour choisir/implanter un accès artériel en pédiatrie. Le temps nécessaire pour compléter le questionnaire est d'environ 10 minutes.

Votre participation est complètement volontaire, il n'y a pas de risques encourus à participer à ce projet. Néanmoins, si vous n'êtes pas à l'aise avec les réponses, vous pouvez quitter le questionnaire à tout moment. Votre opinion nous est précieuse.

Vos réponses seront traitées de manière strictement confidentielle et les donnée récoltées sont destinées à être présentées, de manière anonymes, uniquement lors de conférences médicales ou publiées dans la littérature médicale scientifique. Vos informations seront codées et resteront confidentielles. Si vous avez des questions, n'hésitez pas à contacter en tout temps les responsables de l'étude, aux adresses emails suivantes:

[email protected]
[email protected]
[email protected]

Nous vous remercions chaleureusement pour votre participation et votre soutien. Pour débuter le questionnaire, veuillez cliquer sur le bouton ci-dessous.
 
 
 
* What is your current position?
 
Staff
 
Fellow
 
Resident
 
Other
 
 
 
 
* In what kind institution do you work most of the time?
 
Primary Pediatric Hospital
 
Secondary Pediatric Hospital
 
Tertiary Pediatric Hospital
 
General Hospital mixed activity (pediatric and adult)
 
Clinic
 
Other
 
 
 
 
* Are you working in a university center?
 
Yes
 
No
 
 
 
* How often do practice pediatric anesthesia per month?
 
<4 days per month (one day per week)
 
4-8 days per month (two days per week)
 
8-12 days per month (three days per week)
 
12-16 days per month (four days per week)
 
> 16 days per month (everyday practice)
 
 
 
* How many years of experience do you have in pediatric anesthesia?
 
<3
 
3-5
 
5-10
 
10-20
 
>20
 
 
 
* Do you place arterial lines in children?
 
yes
 
no
 
 
 
* How often do you place an arterial line?
 
Very occasionally (1-5 per year)
 
Less than one per month (6-12 per year)
 
Between one and two per month (13-24 per year)
 
More than two per month but less than one per working day (25-42 per year)
 
More than one per week (more than 42 per year)
 
 
 
* Do you have local guidelines for arterial cannualtion?
 
yes
 
no
 
 
 
* In your experience what is the most common sites for complications related to arterial cannulation?
(Please drag and rank the following cannulation sites by decreasing frequency of complications)
Drag your choices here to rank them
     
     
     
    * What is your preferred site to start arterial cannulation?
    Please drag and rank the following in order of decreasing interest:
    Drag your choices here to rank them
       
       
       
      * What technique do you use to cannulate the artery (percutaneous approach)?
       
      "Going through posterior wall and draw back"
       
      " Puncturing and threading it (without hitting posterior wall)"
       
      I use a wire to assist cannulation (any technique above)
       
      I do not use a specific technique
       
      Other
       
       
       
       
      * What do you consider a failure of cannulation?
      (multiple answers possible)
       
      Number of attempts (without hitting the artery = no back flow of blood) => PLEASE SPECIFIY the number in the box below
       
      Time limit rather then number of attempts => PLEASE SPECIFIY the minutes in the box below
       
      Hematoma (not compromising the vascular supply but lost landmarks)
       
      Blanching of the extremity supplied by the cannulated artery (even if arterial wave displayed)
       
      Hitting the artery but threading of catheter is impossible or very difficult
       
      Maximal number or minutes of attempts
       

       
       
       
      * If you fail the cannulation and decide to change site (arterial supply not compromised), what do you do?
      (please rank by decreasing level of preference: 1 = first choice - 5 = last choice):
      Staying at the same level, same limb (i.e., radial vs ulnar)
      Changing level. same limb (i.e., radial vs brachial)
      Changing limb
      Ask/perform cut down (any site)
      Umbilical artery (if not first choice)
       
       
       
      * How many sites do you try before going/asking to cut-down?
       
      1
       
      2
       
      >2
       
      I do not go/ask for cut-down
       
       
       
      * What kind of material do you use for cannulation?
       
      Venous canula (for exemple Jelco)
       
      I do not have a specific pediatric material
       
      Specific arterial access material (if yes, please specify)
       
       
       
       
      * To locate the artery, what technique do you use?
      (multiple answers possible)
       
      Anatomical landmarks and/or palpation
       
      Doppler Ultrasound (accoustic signal) before the puncture (pre-procedural scan)
       
      Puncture assisted with Doppler Ultrasound (realtime needle survey)
       
      2D Ultrasound (i.e. screen display) before the puncture (pre-procedural scan)
       
      Puncture assisted with 2D Ultrasound (realtime needle survey)

       
       
       
      * How often do you use Doppler ultrasound (accoustic signal) to assist arterial line placement?
       
      Always
       
      Never
       
      Sometimes
       
      Only as rescue
       
       
       
      Can you explain why you use "Always" Doppler (accoustic signal) for arterial cannulation in children?
      (multiple answers possible)
       
      I find it more secure than blind technique
       
      I have more first pass success
       
      It is important for teaching reason
       
      Other
       

       
       
       
      Can you explain why you use "Never" Doppler for arterial cannulation in children?
      (multiple answers possible)
       
      I'm not trained wit this technique
       
      Doppler technique is not accurate enough
       
      I do not have access to Doppler
       
      Other
       

       
       
       
      Can you explain why you use Can you explain why you use "Sometimes" Doppler (accoustic signal) for arterial cannulation in children?
       
      I find it more secure than blind technique
       
      I have more first pass success
       
      It is important for teaching reason
       
      Other
       

       
       
       
      * How often do you use 2 dimensions (2D) Ultrasound to assist arterial line placement?
       
      Always
       
      Never
       
      Sometimes
       
      I do not have access to 2D ultrasound
       
       
       
      You "Always" use 2D ultrasound for the placement of arterial lines. Can you explain what are the advantages?
      (multiple answers possible)
       
      It is superior to Doppler ultrasound/landmarks technique to detect anatomical variations
       
      Teaching interest
       
      The learning curve is faster than with traditional palpation/landmarks technique
       
      I have more first pass success/I need less time to cannulate the artery
       
      I always measure the diameter of the artery to choose the best catheter (PLEASE SPECIFIY your best ratio of catheter to artery)?
       

       
       
       
      You "Sometimes" use 2D ultrasound for the placement of arterial lines. Please, define your level of competency with 2D Ultrasound for arterial line placement?
       
      I feel I am very competent in the use of 2D Ultrasound for arterial line placement
       
      I have some experience in the use of 2D Ultrasound for arterial line placement
       
      I feel I do not have the appropriate experience/training to use 2D Ultrasound for arterial line placement
       
       
       
      You "Never" use 2D ultrasound for arterial line placement. Which of the statements best describes your rational?
      (multiple answers possible)
       
      I do not have the appropriate experience/training to use 2D Ultrasound for arterial line placement
       
      I do not have access to the 2D Ultrasound in your department
       
      I do not believe that in my clinical practice 2D Ultrasound for arterial line placement offers any advantages over a landmark technique
       
      I would use it more frequently with appropriate training
       
      Other
       

       
       
       
      In case you put a femoral arterial line in a full term 1 month baby, what size of catheter would you use?
       
      24 Gauge iv catheter (i.e., Jelco)
       
      22 Gauge iv catheter (i.e., Jelco)
       
      2.5 Fr 5 cm
       
      2.5 Fr 8 cm
       
      3 Fr 5 cm
       
      4 Fr
       
      Other
       
       
       
       
      * In case of bleaching of the extremity after an uneventful cannulation, what would do you usually do? (Multiple choices)
       
      Remove the cannula immediately
       
      Wait and monitor the extremity with O2 saturation (look for arterial wave and saturation)
       
      Warm the extremity
       
      Administer a small dose of lidocaine to resolve the most likely vasospasm
       
      Administer a small dose of papaverine to resolve the most likely vasospasm
       
      Administer a bolus of heparin (please specify the amount of units under "other")
       
      Increase the rate/amount of heparin in the pump
       
      Other
       

       
       
       
      If you have decided to remove the cannula immediately, what arterial site would you choose then, considering the perfusion of the limb is borderline?
       
      I stay at the same level, same limb (i.e., radial vs ulnar)
       
      I change level, stay same limb (i.e., radial vs brachial or axillar)
       
      I change limb
       
      I would go for cut down (please specify under "other"
       
      Other
       

       
       
      This question is related to your technique to keep the arterial access patent, regarding the site:
      NS (normal saline) bag under pressure with intermittent flush NS <1 ml/h NS 1 ml/h NS 2 ml/h NS >2 ml/h Heparin 1 UI/ml at <1 ml/h Heparin 1 UI/ml at 1 ml/h Heparin 1 UI/ml at 2 ml/h Heparin 1 UI/ml at >2 ml/h Heparin 2 UI/ml at <1 ml/h Heparin 2 UI/ml at 1 ml/h Heparin 2 UI/ml at 2 ml/h Heparin 2 UI/ml at >2 ml/h Heparin >2 UI/ml
      Radial
      Ulnar
      Brachial
      Axillar
      Femoral
      Tibial posterior
      Dorsalis pedis
      Umbilical
       
       
       
      Thank you for taking part to this survey. Do you have any comments/suggestions regarding it?
         
       
       
      If you would like to receive a copy of the results, please leave your contact information:
      First Name : 
      Last Name : 
      Email Address :