[Development of a safe technique for central venous access in pediatrics. Our experience with 700 percutaneous...

Since 1977, the authors have performed 708 percutaneous catheterizations of superior vena cava in pediatric patients (from premature infant of 15 year old children). The greater part of these catheterizations concerns the internal jugular vein. Subclavian catheterization was rapidly abandoned because it is judged too dangerous in children. The evolution of the quality of materials, and the increasing technical experience of operators, both allowed to enlarge indications of percutaneous catheterization. That suppose a nearly total suppression of mechanical and infectious complications. The analysis of 7 severe vascular injuries in 445 patients made the authors change their technics and apply a very strict method: choice of a frontal access to internal jugular vein; catheterization performed in operating room, under anesthesia; percutaneous puncture with a lew diameter short catheter (external diameter: 9/10 mm); Seldinger technic and radioscopy; silicone catheters with or without a cuff, systematic tunellisation; operators having a very good practice of venous access in children. The analysis of the three last years shows no immediate mechanical complication and very little infections among 263 catheterizations.