Ultrasound-guided venous access: “Wire-loaded puncture” technique for paediatric cancer patients

Ultrasound-guided venous access is becoming a standard technique in many centers worldwide. In small veins and in the pediatric population, successful venous puncture is sometimes followed by resistance in passing the wire. The needle seems to miss the small vein during syringe dismounting, wire mounting and wire advancement through the needle. This work describes a “wire-loaded puncture” technique as a solution for this problem. Patients and methods: Paediatric cancer patients who needed venous access for different indications were included in the study. The wire-loaded technique is described in detail, with special emphasis on the pitfalls of needle guidance under ultrasound in the “out of plane” technique. One-hundred and thirty-nine (139) procedures were initially included using different ultrasound and different access sets. Different operators have participated in the work. Data of patients were retrospectively collected. Results: One-hundred and thirty-nine (139) paediatric cancer patients were initially included in the study. After exclusion of patients with inaccurate data registration, the number of patients decreased to 132. The most common primary pathology was leukemia, 47 cases (33.8%), and Porta-cath was the most commonly used catheter in 70 (50.3%) cases. The right internal jugular vein (IJV) was the most commonly used vein for access in 111 (79.8%) cases. The access was feasible in 130 out of 132 cases from a single puncture. No procedure related complications were recorded. Conclusion: The “wire-loaded puncture” technique is a useful technique, particularly in small veins overcoming the relatively common problem of “resisting wire” after a successful vein entry. The technique has a reasonable learning curve and has shown to be reproducible by different operators, machines and venous access sets. A high resolution ultrasound machine is recommended.