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Central venous access in children: indications, devices, and risks
Guillermo Ares1, Catherine J Hunter
1Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Insights
Ultrasound guidance and proper catheter tip placement reduce central venous catheter complications in children. Adhering to care protocols is essential for preventing infections like CLABSI.
Area of Science:
- Pediatric critical care medicine
- Vascular access devices
- Infection control
Background:
- Central venous catheters (CVCs) are vital for neonates and children's diagnosis and therapy.
- Reducing complications, especially central line-associated bloodstream infections (CLABSIs), is a key focus for healthcare systems.
Purpose of the Study:
- To review indications for CVC use and available devices.
- To highlight best practices and future research for minimizing CVC complications.
Main Methods:
- Systematic reviews of randomized trials.
- Analysis of recent randomized trials in pediatric CVCs.
- Review of evidence on CVC placement techniques and infection prevention strategies.
Main Results:
- Ultrasound guidance for CVC placement in children is safer than blind techniques for internal jugular vein access.
- Appropriate catheter tip placement correlates with fewer complications.
- Ethanol lock prophylaxis and antibiotic-coated CVCs show promise in reducing CLABSI rates.
Conclusions:
- While landmark techniques remain valid, ultrasound guidance improves CVC placement safety.
- Strict adherence to CVC care protocols is crucial for preventing infectious complications.
Purpose Of Review:
Central venous catheters (CVCs) have a prominent role in the diagnostic and therapy of neonates and children. Herein, we describe the multiple indications for CVC use and the different devices available for central venous access. Given the prevalent use of CVCs, healthcare systems are focused on reducing complications from their use, particularly central line-associated bloodstream infections (CLABSIs). The most up-to-date information available sheds light on best practices and future areas of investigation.
Recent Findings:
Large systematic reviews of randomized trials suggest that ultrasound guidance for placement of CVCs in children is safer than using blind technique, at least for internal jugular vein access. Appropriate catheter tip placement is associated with decreased complications. Furthermore, the prophylactic use of ethanol lock between cycles of parenteral nutrition administration has reduced the rates of CLABSI. A recent randomized trial in pediatric CVCs showed a benefit with antibiotic-coated CVCs.
Summary:
Based on the available evidence, multiple techniques for CVC placement are still valid, including the landmark technique based on practitioner experience, but ultrasound guidance has been shown to decrease complications from line placement. Adherence to CVC care protocols is essential in reducing infectious complications.
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