title: Tips and tricks to facilitate ultrasound-guided placement of peripheral nerve catheters in children.
abstract: OBJECTIVE
  To describe an approach to facilitate ultrasound (US)-guided placement of peripheral nerve catheters in children.
  
  
  BACKGROUND
  Continuous peripheral nerve blocks (CPNB) provide excellent surgical anesthesia and postoperative analgesia. However, catheters can be difficult to place, especially in children.
  
  
  METHODS
  Ten US-guided peripheral nerve catheters were placed and placement difficulties encountered were recorded. Four series of 15 consecutive US-guided CPNB were then performed, adding in each series one possible solution to each of the troubles previously encountered. Finally, all maneuvers were employed in the placement of 15 US-guided CPNB in children 3-10 years old and then followed clinically.
  
  
  RESULTS
  Initial difficulties encountered were as follows: (i) introducing the catheter, (ii) catheter tip visualization, (iii) length of catheter to be introduced, and (iv) catheter fixation and appropriate long-lasting dressing. The proposed facilitating procedure that addresses each of these difficulties is as follows: (i) three-hand technique: an assistant's hand holds the US transducer, the proceduralist anesthetist slightly withdraws and rotates the needle tip with one hand and advances the catheter with the other, (ii) needle visualization in long axis (LAX) whenever possible with catheter placed inside the needle and US guidance of spread of local anesthetic (LA) through the catheter, (iii) catheter advanced until resistance is found or up to a maximum of 5 cm, and (iv) subcutaneous tunneling of the catheter, Dermabond glue, and careful transparent dressing. All catheters in the last series were 100% effective during surgery and provided complete analgesia for ≥3 days without complications.
  
  
  CONCLUSIONS
  Continuous peripheral nerve blocks in children should be placed under US guidance in LAX whenever possible, with a three-hand technique and slightly withdrawing or rotating the needle tip to introduce the catheter, administering LA through the catheter, and performing subcutaneous tunneling and careful dressing.
authors.affiliation: Department of Anaesthesiology, Sant Joan de Déu Women and Children's Hospital, University of Barcelona, Via Augusta 337, Barcelona, Spain. bdejosemaria@hsjdbcn.org
authors.forename: Belén
authors.initials: B
authors.lastname: de José María
authors.forename: Ester
authors.initials: E
authors.lastname: Banús
authors.forename: Montse
authors.initials: M
authors.lastname: Navarro-Egea
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Banchs
mesh_terms: D000765:Anesthesia, Conduction; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D001458:Bandages; D001917:Brachial Plexus / Q000000981:diagnostic imaging; D002404:Catheterization / Q000379:methods*; D057785:Catheters; D002648:Child; D002675:Child, Preschool; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008297:Male; D009407:Nerve Block / Q000379:methods; D010525:Peripheral Nerves / Q000000981:diagnostic imaging*; D013514:Surgical Procedures, Operative; D014463:Ultrasonography
chemical_list: D000779:Anesthetics, Local