Hostname: page-component-77c89778f8-5wvtr Total loading time: 0 Render date: 2024-07-19T02:06:13.689Z Has data issue: false hasContentIssue false
  • English
  • Français

Intramuscular ketamine to facilitate pediatric central vascular access

Published online by Cambridge University Press:  21 May 2015

T. Kent Denmark ,
Jenny R. Hargrove  and
Lance Brown
T. Kent Denmark*
Affiliation:
Department of Emergency Medicine, Loma Linda University Medical Center and Children’s Hospital, Loma Linda, Calif.
Jenny R. Hargrove
Affiliation:
Department of Emergency Medicine, Loma Linda University Medical Center and Children’s Hospital, Loma Linda, Calif.
Lance Brown
Affiliation:
Department of Emergency Medicine, Loma Linda University Medical Center and Children’s Hospital, Loma Linda, Calif.
*
Department of Emergency Medicine, A-108 Loma Linda University Medical Center and Children’s Hospital, 11234 Anderson St., Loma Linda CA 92354 USA; 909 558-4344, fax 909 558-0121, KDenmark@adelphia.net

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objectives:

Obtaining prompt vascular access in young children presenting to the emergency department (ED) is frequently both necessary and technically challenging. The objective of our study was to describe our experience using intramuscular (IM) ketamine to facilitate the placement of central venous catheters in children presenting to our ED needing vascular access in a timely fashion.

Methods:

We performed a retrospective medical record review of all pediatric patients <18 years of age who presented to our tertiary care pediatric ED between May 1, 1998, and August 7, 2003, and underwent the placement of a central venous catheter facilitated by the use of IM ketamine.

Results:

Eleven children met our inclusion criteria. Most of the children were young and medically complicated. The children ranged in age from 6 months to 8 years. The only complication identified was vomiting experienced by an 8-year-old boy. Emergency physicians successfully obtained central venous access in all subjects in the case series.

Conclusions:

The use of IM ketamine to facilitate the placement of central venous catheters in children who do not have peripheral venous access appears to be helpful. Emergency physicians may find it useful to be familiar with this use of IM ketamine.

Keywords

ketaminecentral venous access
Type
Pediatric EM • Pédiatrie D’urgence
Information
Canadian Journal of Emergency Medicine , Volume 6 , Issue 4 , July 2004 , pp. 259 - 262
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

References

1.Reynolds, S, Desguin, B, Uyeda, A, Davis, AT.Children with chronic conditions in a pediatric emergency department. Pediatr Emerg Care 1996;12:166–8.CrossRefGoogle Scholar
2.Sacchetti, A, Gerardi, M, Barkin, R, Santamaria, J, Cantor, R, Weinberg, J, et al. Emergency data set for children with special needs. Ann Emerg Med 1996;28:324–7.CrossRefGoogle ScholarPubMed
3.Celermajer, DS, Robinson, JT, Taylor, JF.Vascular access in previously catheterized children and adolescents: a prospective study of 131 consecutive cases. Br Heart J 1993;70:554–7.Google Scholar
4.Chiang, VW, Baskin, MN.Uses and complications of central venous catheters inserted in a pediatric emergency department. Pediatr Emerg Care 2000;16:230–2.CrossRefGoogle Scholar
5.Glaeser, PW, Losek, JD, Nelson, DB, Bonadio, WA, Smith, DS, Walsh-Kelly, C, et al. Pediatric intraosseous infusions: impact on vascular access time. Am J Emerg Med 1988;6:330–2.Google Scholar
6.Brunette, DD, Fischer, R.Intravascular access in pediatric cardiac arrest. Am J Emerg Med 1988;6:577–9.Google Scholar
7.Wilson-Storey, D.Just a ‘wee prick’ with a needle. J R Coll Surg Edinb 1996;41:412–3.Google ScholarPubMed
8.McGlone, RG, Ranasinghe, S, Durham, S.An alternative to “brutacaine”: a comparison of low dose intramuscular ketamine with intranasal midazolam in children before suturing. J Accid Emerg Med 1998;15:231–6.Google Scholar
9.Caro, DB.Trial of ketamine in an accident and emergency department. Anaesthesia 1974;29:227–9.Google Scholar
10.Dailey, RH, Stone, R, Repert, W.Ketamine dissociative anesthesia — Emergency department use in children. JACEP 1979;8:57–8.CrossRefGoogle ScholarPubMed
11.Green, SM, Rothrock, SG, Lynch, EL, Ho, M, Harris, T, Hestdalen, R, et al. Intramuscular ketamine for pediatric sedation in the emergency department: safety profile in 1,022 cases. Ann Emerg Med 1998;31:688–97.Google Scholar
12.Morray, JP, Lynn, AM, Stamm, SJ, Herndon, PS, Kawabori, I, Stevenson, JG.Hemodynamic effects of ketamine in children with congenital heart disease. Anesth Analg 1984;63:895–8.Google Scholar
13.Jobeir, A, Galal, MO, Bulbul, ZR, Solymar, L, Darwish, A, Schmaltz, AA.Use of low-dose ketamine and/or midazolam for pediatric cardiac catheterization. Pediatr Cardiol 2003;24:236–43.Google Scholar
14.McGown, RG.A technique of anaesthesia in haemorrhagic shock. Illustrative cases histories and a discussion. Anaesthesia 1975;30:616–23.Google Scholar
15.Green, SM, Klooster, M, Harris, T, Lynch, EL, Rothrock, SG.Ketamine sedation for pediatric gastroenterology procedures [published erratum appears in J Pediatr Gastroenterol Nutr 2001;32(2):234]. J Pediatr Gastroenterol Nutr 2001;32(1):26–33.Google Scholar
16.Chowdhary, SK, Parashar, K, Buick, RG, Gornall, P, Corkery, JJ.Central-venous access through the peripheral route in surgical neonates: an audit of 125 consecutive lines from a regional neonatal centre. Pediatr Surg Int 2001;17:433–5.Google Scholar
17.Lu, DP, Lu, GP, Reed, JF3rd. Safety, efficacy, and acceptance of intramuscular sedation: assessment of 900 dental cases. Compendium 1994;15:1348,1350, 1352.Google ScholarPubMed
18.Cotsen, MR, Donaldson, JS, Uejima, T, Morello, FP.Efficacy of ketamine hydrochloride sedation in children for interventional radiologic procedures. AJR Am J Roentgenol 1997;169:1019–22.Google Scholar
19.Mason, KP, Michna, E, DiNardo, JA, Zurakowski, D, Karian, VE, Connor, L, et al. Evolution of a protocol for ketamine-induced sedation as an alternative to general anesthesia for interventional radiologic procedures in pediatric patients. Radiology 2002;225:457–65.Google Scholar
20.Green, SM, Denmark, TK, Cline, J, Roghair, C, Abd Allah, S, Rothrock, SG.Ketamine sedation for pediatric critical care procedures. Pediatr Emerg Care 2001;17:244–8.Google Scholar
21.Green, SM, Nakamura, R, Johnson, NE.Ketamine sedation for pediatric procedures: Part 1, A prospective series. Ann Emerg Med 1990;19:1024–32.Google Scholar
22.Pitetti, RD, Singh, S, Pierce, MC.Safe and efficacious use of procedural sedation and analgesia by nonanesthesiologists in a pediatric emergency department. Arch Pediatr Adolesc Med 2003;157:1090–6.CrossRefGoogle Scholar
23.Pruitt, JW, Goldwasser, MS, Sabol, SR, Prstojevich, SJ.Intramuscular ketamine, midazolam, and glycopyrrolate for pediatric sedation in the emergency department. J Oral Maxillofac Surg 1995;53:13–7.Google Scholar
24.McCarty, EC, Mencio, GA, Walker, LA, Green, NE.Ketamine sedation for the reduction of children’s fractures in the emergency department. J Bone Joint Surg Am 2000;82–A:912–8.Google Scholar
25.Green, SM, Hummel, CB, Wittlake, WA, Rothrock, SG, Hopkins, GA, Garrett, W.What is the optimal dose of intramuscular ketamine for pediatric sedation? Acad Emerg Med 1999;6:21–6.Google Scholar