Ultrasound-Guided Radial Artery Catheterization in a Four-Month-Old Boy
Jun Takeshita, MD, PhD
Osaka Women’s and Children’s Hospital
Ultrasound-guided radial artery catheterization is increasingly used in pediatric patients because it improves procedural accuracy and may enhance first-pass success in infants and small children with small-caliber arteries. Dynamic needle tip positioning (DNTP), a short-axis out-of-plane ultrasound-guided technique, facilitates repeated identification of the true needle tip during needle advancement and enables precise catheter placement.
This video demonstrates ultrasound-guided radial artery catheterization using the DNTP technique in a 4-month-old, 5.5-kg infant with tetralogy of Fallot undergoing a right-sided systemic-to-pulmonary shunt procedure. Because ipsilateral shunt flow may interfere with accurate arterial pressure monitoring, the left radial artery was selected for cannulation. The video illustrates key technical aspects of DNTP, including stepwise needle and probe advancement to maintain visualization of the true needle tip, as well as practical considerations for minimizing complications. It also emphasizes strict aseptic technique, including maximal sterile barrier precautions, a sterile ultrasound probe cover, and sterile ultrasound gel.
The arterial catheter was successfully placed without immediate complications and functioned appropriately throughout the procedure. This video provides a practical demonstration of DNTP and highlights procedural planning and infection prevention strategies for safe and effective pediatric radial artery catheterization.
Ultrasound-Guided Rectus Sheath Block in a Pediatric Patient
Jun Takeshita, MD, PhD
Osaka Women’s and Children’s Hospital
Rectus sheath block (RSB) is a regional anesthesia technique in which a local anesthetic is injected between the posterior aspect of the rectus abdominis muscle and the posterior rectus sheath to block the anterior cutaneous branches of the thoracoabdominal nerves. In pediatric patients, RSB is particularly useful for surgeries performed through umbilical or circumumbilical incisions, such as umbilical hernia repair, laparoscopic surgery with umbilical port placement, pyloromyotomy for hypertrophic pyloric stenosis, and surgery for duodenal atresia, intestinal malrotation, or ovarian cysts. Ultrasound guidance improves the precision and safety of the block by enabling direct visualization of the rectus abdominis muscle, posterior rectus sheath, and underlying peritoneum.
This video demonstrates ultrasound-guided bilateral RSB in a 27-day-old, 3.9-kg neonate undergoing circumumbilical pyloromyotomy for hypertrophic pyloric stenosis. The video highlights the key technical aspects of the procedure, including the identification of the posterior rectus sheath, continuous visualization of the needle tip, appropriate lateral placement of the local anesthetic within the posterior rectus sheath plane, and measures to avoid peritoneal puncture and vascular injury. Particular attention is also given to the conservative dosing of ropivacaine in neonates to minimize the risk of local anesthetic systemic toxicity.
Pediatric Infant Bilateral Open Inguinal Hernia Repair – Twin B
Casey L. Meier, RN1; Lissa Henson, MD2; Domingo Alvear, MD3
1Lincoln Memorial University, DeBusk College of Osteopathic Medicine
2Philippine Society of Pediatric Surgeons
3World Surgical Foundation
Indirect inguinal hernia repair is a common procedure for premature infants because of the frequency of a patent processus vaginalis. Prompt surgical correction decreases the risk of incarceration, strangulation, and necrosis in children. There are various techniques for herniorrhaphy. This repair demonstrates an open bilateral indirect inguinal hernia repair in an infant that avoids high ligation by closing the internal inguinal ring, utilizing a purse-string method to keep the hernia sac intact. This approach limits the amount of anesthesia used and prevents excess bleeding, making it safe, effective and efficient.
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