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Peripherally inserted central catheters in infants and children - indications, techniques, complications and clinical
B Westergaard1, V Classen, S Walther-Larsen
1Department of Anaesthesia, Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Insights
Peripherally inserted central catheters (PICCs) are a safe and effective option for intermediate- to long-term venous access in children beyond the neonatal age. With proper care and ultrasound guidance, PICCs offer low complication rates, making them a valuable choice for pediatric patients.
Area of Science:
- Pediatric Medicine
- Vascular Access
- Critical Care
Background:
- Venous access is crucial for administering medication and nutrition to pediatric patients.
- Peripherally inserted central catheters (PICCs) are established in adults and neonates, but their utility in older children requires specific evaluation.
- Traditional central venous catheters pose risks, necessitating exploration of alternatives for pediatric populations.
Purpose of the Study:
- To review indications, insertion methods, and complications of PICCs in children beyond the neonatal period.
- To provide clinical recommendations for PICC use in pediatric patients based on current literature.
- To assess the safety and efficacy of PICCs as an alternative to traditional central venous access in children.
Main Methods:
- Comprehensive literature search on PICC lines in pediatric patients (excluding neonates).
- Review of studies focusing on indications, insertion techniques, and associated complications.
- Synthesis of evidence to formulate clinical recommendations.
Main Results:
- PICCs are a safe and valuable option for intermediate- to long-term central venous access in pediatric patients.
- Insertion is often feasible with minimal sedation and low perioperative risk.
- Ultrasound-guided insertion significantly improves success rates.
- Mechanical, infectious, and thrombotic complication rates are low with proper catheter care.
- Fibrinolytics and antibiotic locks can often salvage catheters experiencing occlusion or infection.
Conclusions:
- PICCs represent a safe and effective strategy for central venous access in children beyond the neonatal age.
- Ultrasound guidance and meticulous catheter care are key to successful PICC implementation and complication avoidance.
- PICCs offer a favorable alternative to traditional central venous catheters in pediatric care, with high retention rates even after complications.
Abstract:
Venous access required both for blood sampling and for the delivery of medicines and nutrition is an integral element in the care of sick infants and children. Peripherally inserted central catheters (PICCs) have been shown to be a valuable alternative to traditional central venous devices in adults and neonates. However, the evidence may not extrapolate directly to older paediatric patients. In this study, we therefore review the indications, methods of insertion and complications of PICC lines for children beyond the neonatal age to provide clinical recommendations based on a search of the current literature. Although the literature is heterogeneous with few randomised studies, PICCs emerge as a safe and valuable option for intermediate- to long-term central venous access in children both in and out of hospital. Insertion can often be performed in light or no sedation, with little risk of perioperative complications. Assisted visualisation, preferably with ultrasound, yields high rates of insertion success. With good catheter care, rates of mechanical, infectious and thrombotic complications are low and compare favourably with those of traditional central venous catheters. Even in the case of occlusion or infection, fibrinolytics and antibiotic locks often allow the catheter to be retained.
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