Pediatric Surgery International

, Volume 34, Issue 5, pp 529–533 | Cite as

Obtaining central access in challenging pediatric patients

  • Cory N. Criss
  • Jake Claflin
  • Matthew W. Ralls
  • Samir K. Gadepalli
  • Marcus D. Jarboe
Original Article

Abstract

Purpose

Central catheter placement is one of the most commonly performed procedures by pediatric surgeons. Here, we present a case series of patients where central access was obtained at our institution with the utilization of a novel ultrasound-guided technique. This series represents the first of its kind where the native, parent vessels were inaccessible, resulting in a challenging situation for providers.

Methods

A retrospective chart review was performed in pediatric patients (0–17 years) at a tertiary care institution between July 2012 and November 2017 on all central line procedures where ultrasound was utilized to cannulate the brachiocephalic or superior vena cava in face of proximal occlusion. Our group has previous experience utilizing an image-guided in-plane approach to central line placement in the pediatric population. Demographics, operative characteristics, and postoperative complications were reviewed.

Results

A total of 11 procedures were included in this case series where the BC (N = 9) or SVC (N = 2) were cannulated for access. Internal jugular vein cannulation was attempted on each patient unless preoperative imaging demonstrated occlusion. The median operative time was 43 ± 23 min. Most procedures were performed on the right sided (63%), with catheters ranging from 4.2F single lumen to 14F double lumen. Since being placed, three (27%) catheters have been removed, with one due to non-use, one due to sepsis, and the final one due to malposition.

Conclusion

With the continued need for long-term central access in the pediatric population, distal vein occlusion or inaccessibility can prove challenging when attempting to obtain central access. Here, demonstrated a safe alternative technique that provides an additional option in the pediatric surgeon’s armamentarium for patients with difficult central access.

Keywords

Ultrasound Brachiocephalic Occluded IJ Image guidance Subclavian Internal jugular Central line Broviac Tunneled line Medi-port 

Abbreviations

BC

Brachiocephalic

IJ

Internal jugular

SVC

Superior vena cava

US

Ultrasound

ESRD

End-stage renal disease

VA

Ventriculoatrial

Notes

Compliance with ethical standards

Conflict of interest

The authors have nothing to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standard.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Cory N. Criss
    • 1
  • Jake Claflin
    • 2
  • Matthew W. Ralls
    • 1
  • Samir K. Gadepalli
    • 1
  • Marcus D. Jarboe
    • 1
  1. 1.Section of Pediatric Surgery, Department of SurgeryMichigan Medicine, C.S. Mott Children’s and Von Voigtlander Women’s HospitalAnn ArborUSA
  2. 2.University of Michigan School of MedicineAnn ArborUSA

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