[Placement of central venous catheters in pediatric anesthesia : Indications, techniques and complications]

Even experienced anesthesiologists can be challenged when establishing a central venous catheter in children. In addition to the classical indications, a difficult peripheral vein access represents a relevant indication for a central venous catheter to avoid repeated traumatic puncture attempts. The size of the catheter utilized depends on the body weight and the vein diameter to prevent thrombotic complications. Irrespective of the chosen vein, the puncture should be performed under direct sonographic visualization of the needle tip and subsequently the wire. The internal jugular vein is the vessel of choice for the site of puncture due to its accessibility for sonography, ease of catheter placement and management as well as valuable hemodynamic information. To avoid exposure to ionizing radiation, the catheter tip positioning should be verified using sonography (transthoracic echocardiography, TTE) or intracavitary electrocardiography (ECG). The indications and dwell time should be critically assessed for all catheter placements to avoid complications such as catheter-associated bloodstream infections and thrombosis.