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Venous catheter at alternate exit site in a 2-year-old requiring long-term antibiotics for osteomyelitis: A case
Matthew D Ostroff1, David Goldberg1, Greg Bauhman1
1St. Joseph's University Medical Center, Paterson, NJ, USA.
Insights
Securing long-term vascular access in children is challenging. A novel bedside technique for tunneling central venous catheters using ECG navigation successfully prevented dislodgement in a pediatric patient.
Area of Science:
- Pediatric vascular access
- Medical device securement
- Minimally invasive procedures
Background:
- Pediatric patients often require long-term intravenous (IV) treatment, posing challenges for vascular access maintenance.
- Peripherally inserted central catheters (PICCs) are common but prone to dislodgement in children due to accidental or purposeful removal.
- Existing securement methods frequently fail, leading to treatment delays.
Observation:
- A case report details a novel bedside approach for a pediatric patient needing long-term IV antibiotics.
- A central venous catheter was placed in the internal jugular vein and tunneled subcutaneously to the dorsal thoracic region.
- The procedure utilized intracavitary electrocardiogram (ECG) navigation under moderate sedation.
Findings:
- The tunneled catheter was successfully placed at the bedside, creating a secure exit site difficult for the patient to reach.
- This technique effectively addresses the common issue of catheter dislodgement in pediatric patients.
- The use of the internal jugular vein and tunneling technique is consistent with traditional methods.
Implications:
- This novel bedside tunneling technique offers a promising solution for preventing catheter dislodgement in pediatric patients.
- It may reduce the need for more invasive procedures or repeated catheter placements.
- Further adoption of this method could improve the reliability of long-term IV treatment delivery in children.
Abstract:
In the pediatric population, vascular access is often challenging to secure and to maintain, especially for long-term intravenous (IV) treatment. The traditional approach for patients who require long-term IV antibiotics is placement of a peripherally inserted central catheter (PICC). The challenge in the pediatric population is the high risk of dislodgement after PICC placement, as these patients tend to pull their line out accidentally or purposefully. Current bedside options to prevent catheter dislodgement include adhesive securement devices, subcutaneous securement devices, sutures, and wrapping the site in gauze. However, these modalities often fail, leading to delay in administration of IV therapies, including life-saving antibiotics.A novel approach to this very common and serious issue is to tunnel the catheter subcutaneously, thereby placing the exit site in a location difficult for the patient to reach. Tunneled catheters generally are placed in children for long-term vascular access and insertion has primarily been reserved for surgeons in the operating room or by interventional radiologists. The following case report describes a central venous access catheter placed in the internal jugular vein and tunneled to the medial dorsal thoracic region successfully at the bedside, using intracavitary electrocardiogram (ECG) navigation under moderate sedation. Although a novel exit site, the technique of tunneling and use of the jugular vein is no different than traditional tunneling techniques therefore it was not deemed necessary to seek internal review board approval.
