Minimizing Complications Associated With Percutaneous Central Venous Catheter Placement in Children

Recent Advances

John M. Costello, MD, MPH; Timothy C. Clapper, PhD; David Wypij, PhD

Disclosures

Pediatr Crit Care Med. 2013;14(3):273-283. 

In This Article

Abstract and Introduction

Abstract

Objectives: To summarize existing knowledge regarding the prevalence of complications associated with temporary percutaneous central venous catheters placed in critically ill children, and to review evolving strategies to minimize the prevalence of these complications.

Data Sources: Literature review was performed: PubMed and EBSCOhost were searched using the terms central venous catheter, children, ultrasound, infection, thrombosis, and thromboembolism in various combinations. Citations of interest from identified articles were also reviewed.

Study Selection: The review focused primarily on pediatric literature relevant to the topic of interest.

Data Extraction and Synthesis: Randomized clinical trials and other prospective studies were discussed in greater detail than retrospective, single-center investigations.

Conclusions: Complications during percutaneous central venous catheter placement in children are not rare and may be in part attributable to abnormalities in vascular anatomy. Thromboses in children with central venous catheters are increasingly recognized as an important problem for which evidence-based preventive measures are lacking. Catheter-associated bloodstream infection rates in critically ill children have markedly decreased over the last decade, associated with an increased emphasis on staff education and the use of insertion and maintenance bundles. Available evidence tends to support the use of two-dimensional ultrasound to augment the landmark technique for catheter placement, but more studies are needed.

Introduction

Percutaneous central venous catheters (CVC) are placed in children for a variety of reasons, including repeated blood sampling, hemodynamic monitoring, difficult peripheral access, and administration of vasoactive medications and parenteral nutrition. CVC placement is more difficult in children than in adults, and neonates and infants are particularly challenging.[1–7] In recent years, a variety of strategies have been used in an effort to minimize the occurrence of complications associated with percutaneous CVC placement. This review summarizes contemporary complications associated with percutaneous CVCs and recent developments relevant to their prevention. Basic descriptions of normal vascular anatomy and the standard Seldinger technique used during CVC insertion may be found in a number of textbooks, and these issues are not discussed in detail.[8,9] Although selected concepts discussed in this article may be relevant to the placement and management of peripherally inserted central catheters, umbilical venous catheters, or surgically or fluoroscopically placed central catheters, these devices will not be specifically addressed.[10]

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