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Long-term IV access in paediatrics - why, what, where, who and how

Mathias Johansen1, Volker Classen2, Karl Muchantef3

  • 1Department of Paediatric Anaesthesia, Montreal Children's Hospital, Montreal, Canada.

Acta Anaesthesiologica Scandinavica
|November 4, 2020
PubMed

Insights

This review covers central venous access devices (CVADs) for children, detailing risks, complications like infections and thrombosis, and optimal management strategies. It also presents a specific technique for inserting tunnelled, cuffed catheters.

Area of Science:

  • Pediatric Medicine
  • Vascular Surgery
  • Medical Devices

Background:

  • Long-term central venous access in children carries risks including procedural complications and catheter-related issues.
  • Complications encompass air embolism, pneumothorax, infections, thrombosis, and stenosis, impacting pediatric patient morbidity and mortality.
  • Syndromic children often present unique anesthetic challenges for central venous access device (CVAD) placement.

Purpose of the Study:

  • To provide a historical and clinical overview of central venous access devices (CVADs) in pediatric long-term use.
  • To detail the origin and management of common CVAD complications, including thrombosis, infections, and occlusion.
  • To update clinicians on the indications, methods, and patient selection for pediatric long-term central venous access.

Main Methods:

  • This narrative review synthesizes existing literature on pediatric central venous access.
  • It examines the development, application, and complications of central venous access devices (CVADs).
  • A specific clinical method for retrograde insertion of a tunnelled and cuffed catheter via the left brachiocephalic vein is presented.

Main Results:

  • Central venous access devices (CVADs) are essential but associated with significant procedural and catheter-related risks.
  • Common complications include catheter-related bloodstream infections, thrombosis, and occlusion, requiring careful management.
  • The review highlights the importance of appropriate patient selection and technique for successful pediatric CVAD placement.

Conclusions:

  • Effective management of pediatric central venous access requires understanding historical context, potential complications, and current best practices.
  • The presented technique offers a specific approach for tunnelled and cuffed catheter insertion in pediatric patients.
  • Optimizing central venous access in children necessitates a comprehensive approach to minimize risks and ensure device longevity.

Keywords:
CVCbrachiocephalic veincatheter related thrombosiscentral venous accessclabsilong termpaediatrictunnelled cathetervascular accessvenous thromboembolism

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