Wireless replacement of the "lost" central venous line in children

Although the achievement of central venous access in children is often difficult maintenance of access is often frustrated by the tendency of the small-caliber central venous line (CVL) to thrombose despite adequate heparinization or-worse yet-be inadvertently removed. Traditional replacement over wire (Seldinger technique) is often not an option for these "lost" CVLs. Over the past 7 years we have used a wireless technique of CVL replacement to re-establish central access in children. The charts of 125 children who underwent wireless CVL replacement at various institutions between January 1995 and July 2000 were retrospectively reviewed. The wireless technique involves replacement of CVL by direct insertion through the previous catheter tract marked by the old puncture site. Plain film was used to confirm the line position postprocedure. The technique was applied predominantly to percutaneously placed 3- to 4-F CVLs with distal port thrombosis or those that had been inadvertently removed. Successful replacement was defined as re-establishment of previous line position and the ability to flush/draw blood through all ports. Wireless replacement was successful in 120 of 125 cases (96.0%). Recannulization was successful in CVLs as new as 3 days old and those removed for as long as 24 hours. Of the five unsuccessful cases, however, two CVLs were >3 weeks old, but >6 hours had elapsed since removal. The remaining three cases were CVLs that were <3 days old. There were no intra- or postoperative complications, notably air embolism. We conclude that wireless CVL replacement in children can be performed safely and successfully in children who have lost central access not amenable to replacement via the traditional Seldinger technique. The often difficult chore of re-establishing central access at a new site in small children can thus be avoided.