Long‐term IV access in paediatrics ‐ why, what, where, who and how

Abstract

Establishment of long‐term central venous access imposes the risk of procedural adverse events (air embolism, pneumothorax, accidental arterial cannulation of the great vessels, tricuspid valve damage and cardiac tamponade) as well as the risk of increased morbidity and mortality due to catheter related blood stream infections, vessel stenosis, deep vein thrombosis and the often high risk anaesthetic management of syndromic children. This narrative review aims to provide a historical and clinical background for the development and use of CVADs (central venous access devices), origin and management of the most common complications (catheter related thrombosis, infections and persistent withdrawal occlusion) and present the reader with an update on the “why, what, where, who and how” in paediatric long‐term central venous access. Finally, we will present the reader with a clinical method for applying a retrograde inserted tunnelled and cuffed catheter using the left brachiocephalic vein access.

Infection Prevention and Management in Pediatric Short Bowel Syndrome

“…Mostly used CV access involves a tunneled CV line inserted via the external or the internal jugular vein (or other upper central veins, e.g., the Subclavian vein) to the cavo-atrial junction ( 13 ). Femoral access is more controversial and, in clinical practice, more problematic ( 14 ). Peripherally inserted central lines may also be used for a short term, but they carry higher infection risks.…”