Obtaining central access in challenging pediatric patients.

Area of Science:

• Pediatric Surgery
• Vascular Access
• Medical Imaging

Background:

• Central catheter placement is a common pediatric surgical procedure.
• Difficulties arise when native vessels are inaccessible, posing challenges for surgeons.
• Ultrasound guidance is increasingly utilized for vascular access procedures.

Purpose of the Study:

• To present a case series of pediatric patients undergoing central venous access using a novel ultrasound-guided technique.
• To demonstrate the utility of this technique when native vessels are inaccessible.
• To evaluate the safety and efficacy of this approach in challenging pediatric cases.

Main Methods:

• Retrospective chart review of pediatric patients (0-17 years) between July 2012 and November 2017.
• Ultrasound-guided cannulation of the brachiocephalic (BC) or superior vena cava (SVC) in cases of proximal occlusion.
• Review of demographics, operative characteristics, and postoperative complications.

Main Results:

• Eleven procedures were included, cannulating the BC (n=9) or SVC (n=2).
• Median operative time was 43 ± 23 minutes, with 63% performed on the right side.
• Three (27%) catheters were removed due to non-use, sepsis, or malposition.

Conclusions:

• Distal vein occlusion or inaccessibility presents a significant challenge for pediatric central venous access.
• This novel ultrasound-guided technique provides a safe alternative for pediatric surgeons.
• The technique expands the armamentarium for managing difficult central access cases in children.