Utility of bedside angiography in the evaluation of vascular obstruction in the pediatric intensive care patient

Objective: To review our experience with bedside angiography in order to demonstrate the utility of this technique for evaluation of blood vessels in the critically ill patient. Design: Retrospective review. Setting: Pediatric cardiac intensive care unit at a children's hospital. Patients: Five patients aged 5 days to 17 yrs in the cardiac intensive care unit at our institution received bedside angiography. Indications for bedside angiography included abnormal radiographic appearance of central catheter location or clinical suspicion of vascular obstruction. Institutional review board approval for this retrospective review was obtained, and the waiver of consent was approved by the institutional review board. Interventions: For angiographic evaluation of blood vessels, a radiographic plate was placed behind the area of blood vessels to be evaluated. Approximately 1 mL/kg of iohexol contrast was injected rapidly by hand into the blood vessel in question. Just at completion of the contrast injection, a radiograph was taken by portable radiograph equipment. Main Results: A total of five patients with potential blood vessel compromise were evaluated by bedside angiography. All angiograms clearly demonstrated the vascular anatomy and catheter location, in addition to identifying areas of obstruction and collateral flow. There were no cases of renal compromise due to contrast use and no blood vessel compromise from contrast injection. Conclusions: Bedside angiography is a rapid, safe, and useful tool for the evaluation of complex vascular anatomy in critically ill patients. In cases where vascular ultrasound is unable to provide detailed anatomy or identify collateral flow, this technique may be useful in providing safe and accurate assessment of blood vessels associated with vascular access devices.