Hybrid interventions for catheter placement in pediatric intestinal rehabilitation patients with end-stage venous access

Sieverding, Ludger; Büsch, Andreas; Gesche, Jens; Blumenstock, Gunnar; Sturm, Ekkehard; Tsiflikas, Ilias; Piersma, Femke R.; Hauser, Anja E.; Wiegand, G.; Hartleif, Steffen; Hofbeck, Michael; Fuchs, Jörg; Warmann, Steven W.

doi:10.1016/j.jpedsurg.2017.03.051

Cited by 7 publications

(5 citation statements)

References 19 publications

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“…Children with chronic intestinal failure depend on permanent central venous catheters for delivery of parenteral nutrition as long as they have not achieved enteral autonomy. The knowledge about the importance of avoiding catheter-related complications has increased over recent years and has led to specific handling recommendations with regard to the central lines ( 7 , 9 – 14 ).…”

Section: Discussionmentioning

confidence: 99%

“…A consensus paper from 2019 defined thrombosis of 3 out of 4 discrete upper body central veins (left subclavian and internal jugular, right subclavian and internal jugular) or occlusion of a brachiocephalic vein in children as one criterion for placement on a waitlist for intestinal transplantation ( 4 ). We recently described the successful use of hybrid central line placement (interventional plus surgical approach) in affected children ( 7 ). Essentially, the procedure consists of 2 basic techniques.…”

Section: Introductionmentioning

confidence: 99%

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Spectrum of Interventional Procedures During Hybrid Central Line Placement in Pediatric Intestinal Rehabilitation Patients With End-Stage Vascular Access

et al. 2022

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BackgroundLoss of available central vein access sites for parenteral nutrition delivery represents one of the main indications for intestinal transplantation in children with intestinal failure. Placement of central venous catheters can be challenging in advanced loss of patent venous pathways. We recently described the hybrid technique (interventional plus surgical approach) of central line placement in children. The aim of this study was to describe and analyze the interventions used during the hybrid procedures regarding feasibility, safety and outcome.MethodsWe retrospectively analyzed the course of all children in our intestinal rehabilitation program undergoing hybrid central line placement. We evaluated patients' conditions, interventional techniques and surgical peculiarities as well as outcome.Results203 children were treated in our intestinal rehabilitation program between 2010 and 2021. Due to loss of venous access, hybrid technique was performed in 53 children during 76 interventions. In 40 cases the same vessel was reused via Seldinger technique. Among the 30 ultrasound-guided new vessel punctures, 12 were performed by puncture of collateral vessels. Extended interventions due to thoracic central venous obstruction and/or thrombosis requiring additional access via a femoral vein for rehabilitation of the vascular system was performed during 29 procedures including catheter extraction (1), angioplasties (18), stent placement (1), revascularization (5) and thrombectomy (4). Placement of a central line was not possible in 6 children which eventually underwent extended thoracic/vascular surgery: in three children the previously placed catheter could not be removed, in one child, placement of a thrombectomy-catheter was not possible because of inferior vena cava occlusion, and in two children, revascularization failed. Intestinal transplantation was considered in one patient because of impending loss of vascular access. Two self-limiting minor extravasations and one intervention-associated pericardial effusion occurred.ConclusionsHybrid interventions for central venous catheter placement and vascular rehabilitation enable a high success rate in children with intestinal failure and end-stage vascular access, circumventing the need for intestinal transplantation or advanced surgery. The relevant procedures are complex and require a foresighted and individualized approach with a wide range of interventional techniques. If performed with expertise, this combined interventional/surgical approach is feasible and safe.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Spectrum of Interventional Procedures During Hybrid Central Line Placement in Pediatric Intestinal Rehabilitation Patients With End-Stage Vascular Access

et al. 2022

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“…fluids and supplemental parenteral nutrition may have permanent vein damage limiting venous access. 7 Assistive technologies can be helpful for all patients requiring I.V. access and particularly for patients with DIVA.…”

Section: Nir Spectroscopymentioning

confidence: 99%

“…Additionally, patients with long-term dependence on I.V. fluids and supplemental parenteral nutrition may have permanent vein damage limiting venous access 7. Assistive technologies can be helpful for all patients requiring I.V.…”

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confidence: 99%

Current and emerging vein identification technology for phlebotomy and peripheral I.V. cannulation

Kaganovskaya

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Wuerz

2023

Nursing

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“…Recently, reports of hybrid approaches for catheter salvage in children have increased, and data are less anecdotal. In 2018, Sieverding et al [61] reported the results of their systematic and comprehensive strategy to approach patients with challenging vascular access. A careful anatomical assessment, associated with the sensible use of all the surgical and interventional radiology armamentarium, allowed the authors to ensure a permanent vascular access in a large group of otherwise extremely challenging patients.…”

Section: Treatment Options Thrombolytic Agents Guidewires Substitutio...mentioning

confidence: 99%

Difficult Vascular Access in Children with Short Bowel Syndrome: What to Do Next?

et al. 2022

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Short Bowel Syndrome and intestinal failure are chronic and severe conditions that may require life-long parenteral nutrition in children. Survival of these children rely on the correct functioning of central venous catheters; therefore, careful management, prevention, and treatment of complications is of paramount importance. Despite a growing awareness of preserving the vascular real estate, a certain number of patients still experience a progressive and life-threatening exhaustion of vascular access. We searched the literature to highlight the current management of children with vascular exhaustion, specifically focusing on vascular access salvage strategies and last-resource alternative routes to central veins. Given the paucity of data, results are reported in the form of a narrative review.

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Hybrid interventions for catheter placement in pediatric intestinal rehabilitation patients with end-stage venous access

Cited by 7 publications

References 19 publications

Spectrum of Interventional Procedures During Hybrid Central Line Placement in Pediatric Intestinal Rehabilitation Patients With End-Stage Vascular Access

Spectrum of Interventional Procedures During Hybrid Central Line Placement in Pediatric Intestinal Rehabilitation Patients With End-Stage Vascular Access

Current and emerging vein identification technology for phlebotomy and peripheral I.V. cannulation

Difficult Vascular Access in Children with Short Bowel Syndrome: What to Do Next?

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