From the Guidelines
For pediatric TIPS procedures, a needle size of 21-gauge or 22-gauge is typically recommended, with the choice depending on the child's size and the specific clinical situation, as smaller gauge needles minimize trauma and bleeding risk. When considering the technical challenges presented by a child's age and size, it is essential to pay particular attention to the type of equipment used, especially in patients under 2 years of age or weighing less than 10 kg 1. The primary indication for TIPS in children is recurrent and/or refractory ascites, and while the decision to proceed with TIPS should consider various factors including the duration since transplant, response to medical treatment, and liver function, the technical aspects of the procedure, such as needle size, are crucial for success.
Key considerations for pediatric TIPS include:
- The child's age and size, which may present technical challenges
- The type of equipment used, particularly in very young or small patients
- The presence of anatomical peculiarities, which can affect the success of the procedure
- The use of covered stents, which are associated with a reduced risk of variceal bleeding recurrence compared to uncovered stents 1
- The importance of a thorough anatomical assessment before considering TIPS, to identify potential causes of placement failure such as extrahepatic portal vein thrombosis or portal trunk hypoplasia.
In terms of specific needle size, while the provided evidence does not explicitly state the recommended needle size for pediatric TIPS, the general principle of using smaller gauge needles in pediatrics to minimize trauma and bleeding risk can be applied. Therefore, a 21-gauge or 22-gauge needle is likely a reasonable choice, with the final decision depending on the individual patient's anatomy and clinical needs, as determined by the interventional radiologist.
From the Research
Pediatric TIPS Needle Size
There is limited information available on the specific needle size for pediatric Transjugular Intrahepatic Portosystemic Shunts (TIPS). However, we can look at related studies on vascular access in pediatric patients for some insights.
- The study 2 discusses the placement of TIPS in children, but it does not provide information on the needle size used.
- A study on gaining vascular access in pediatric patients 3 mentions the use of 18-, 20-, or 22-gauge bare needles with an inserted Doppler stylet for internal jugular vein cannulation or femoral artery cannulation.
- Other studies 4, 5, 6 focus on intraosseous needle placement, ultrasound-guided peripheral venous catheterization, and radiographic measurements for IO needle placement in pediatric patients, but they do not provide direct information on TIPS needle size.
Related Needle Sizes
While not directly related to TIPS, the following needle sizes have been mentioned in studies on pediatric vascular access: