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An Alternative Central Venous Access Route for Pediatric Patients with Chronic Critical Illness: The Transhepatic
Hasan Bilen Onan1, Ferhat Can Piskin2, Sinan Sozutok1
1Department of Radiology, Balcali Hospital, Medical Faculty Cukurova University, Adana, 38000, Turkey.
Insights
The transhepatic approach offers a safe and effective method for central venous catheterization in chronically critically ill children. This technique provides a viable long-term vascular access solution for pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Vascular access procedures
- Interventional radiology
Background:
- Central venous catheters are essential for managing chronic critical illness in pediatric patients.
- Traditional venous access routes can be challenging in this population.
- The transhepatic approach presents a potential alternative for difficult vascular access.
Purpose of the Study:
- To assess the safety and functionality of the transhepatic approach for central venous catheterization.
- To evaluate its efficacy as an alternative route in pediatric patients with chronic critical illness.
Main Methods:
- Retrospective analysis of 12 pediatric patients undergoing transhepatic central venous catheterization.
- Data collected included indications, procedure specifics, catheter patency, and complications.
- Procedures utilized ultrasonography and fluoroscopy guidance.
Main Results:
- 16 central venous catheters were successfully placed via the transhepatic route.
- Mean catheter patency was 132.1 days.
- One case of catheter-related sepsis and six instances of malposition-related dysfunction were reported.
Conclusions:
- The transhepatic approach is a safe and functional option for long-term central venous access in pediatric chronic critical illness.
- High technical success rates were achieved using ultrasound and fluoroscopy.
- Tunneled catheters placed via this method demonstrated sustained functionality.
Objective:
To evaluate the safety and functionality of the transhepatic approach as an alternative route for central venous catheterization in pediatric patients with chronic critical illness.
Methods:
The study included data of 12 chronic critically ill pediatric patients who underwent central venous catheterization with transhepatic approach. The indications, procedure details, mean patency time, and catheter-related complications were retrospectively analyzed.
Results:
A total of 16 central venous catheters were placed through the transhepatic approach. A 5F port catheter was used in eight attempts, a 5F PICC in two attempts, and an 8-14F Hickman-Broviac catheter in six attempts. All procedures were performed with technical success. The mean patency time of the catheters was 132.1 d (range: 12-540 d). In the long-term follow-up, catheter-related sepsis was detected in a patient, and six catheters lost functionality due to malposition.
Conclusion:
The transhepatic approach is a safe and functional alternative route for central venous access in chronic critically ill pediatric patients requiring long-term vascular access. The procedure using ultrasonography and fluoroscopy can be performed with high technical success. In the long-term follow-up, Dacron felt cuff tunneled catheters placed in the subcostal space with a transhepatic approach remained functional for a long time.
