[Central venous lines in children: new trends].

Area of Science:

• Pediatric critical care medicine
• Vascular access procedures
• Medical imaging applications

Background:

• Central venous catheterization is a common procedure in pediatric and adult critical care.
• Traditional landmark-based methods carry risks, including complications and longer procedure times.
• Ultrasound (US) guidance has emerged as a superior alternative for central venous catheter placement.

Purpose of the Study:

• To evaluate the efficacy and safety of two-dimensional ultrasound (US) guidance for central venous catheterization compared to the landmark method.
• To determine the ideal tip location for central venous catheters in pediatric and adult patients to minimize complications.
• To assess the need for routine antithrombotic prophylaxis in children with long-term central venous catheters.

Main Methods:

• Review of existing literature on ultrasound-guided central venous catheterization techniques.
• Analysis of studies comparing ultrasound guidance with the classical landmark method in adults and children.
• Investigation of the impact of catheter tip location on complication rates, including perforation, tamponade, venous thrombosis, and catheter malfunction.
• Evaluation of specific recommendations for catheter tip placement based on patient age, weight, and catheter type.

Main Results:

• Ultrasound guidance is quicker and safer than the landmark method for central venous catheterization in both pediatric and adult populations.
• Preoperative ultrasound location followed by blind or US-guided puncture is a viable alternative when difficulties are anticipated.
• Catheter tip malposition, particularly in small premature infants with polyurethane catheters placed in cardiac cavities, increases risks of perforation and tamponade.
• Short catheters with tips above the T3-T4 level are associated with increased venous thrombosis and malfunction in children and adults.
• The optimal tip location for long-term central venous catheters, excluding polyurethane catheters in small premature infants, is the superior vena cava-right auricle junction.

Conclusions:

• Two-dimensional ultrasound guidance represents the gold standard for central venous catheterization, enhancing safety and efficiency.
• Precise catheter tip placement, specifically at the superior vena cava-right auricle junction, is crucial for minimizing complications in most pediatric and adult patients.
• Routine antithrombotic prophylaxis is not currently recommended for children with long-term central venous catheters.