Arterial and central venous access is challenging in children due to their smaller and more mobile vessels. In addition, short and long-term damage to vessels is more likely in children due to the limited catheter sizes available for venous and arterial access. Peripherally Inserted Central Catheters (PICC) avoid children needing multiple peripheral intravenous catheters, and often facilitate treatment as an outpatient. Tunneled, cuffed central catheters (Hickman or Broviac) may last several months and are preferred for oncology treatment. Vascular access may cause thrombosis in the short term, and vessel stenosis in the longer term, which may affect subsequent access for the child. The size of the catheter relative to the size of the vein affects the likelihood of vessel damage, and in general the vein should be at least three times the diameter of the catheter. Multidisciplinary vascular access teams have evolved to develop insertion skills for a variety of catheter devices, and to have an active role in device selection, timing of insertion, and to assist with management and troubleshooting of the device. These teams can be nurse-led and they ensure the appropriate device is chosen to complete the planned duration of therapy without the need for re-insertion or replacement of the device.
Central venous access in children Ultrasound for arterial catheters Pediatric central venous access devices Broviac catheter Pediatric infusaport
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Amerasekera SSH, et al. Imaging of the complications of peripherally inserted central venous catheters. Clin Radiol. 2009;64:832–40. An article about PICC insertion in adults, but a very good discussion of anatomy and complications.CrossRefGoogle Scholar
Baskin KM, et al. Cavoatrial junction and central venous anatomy: implications for central venous access tip position. J Vasc Interv Radiol. 2008;19:359–65.CrossRefGoogle Scholar
Bodenham A, et al. Association of anaesthetists of Great Britain and Ireland—safe vascular access 2016. Anaesthesia. 2016;71:573–85.CrossRefGoogle Scholar
Connolly B, et al. Fluoroscopic landmark for SVC-RA junction for central venous catheter placement in children. Pediatr Radiol. 2000;30:692–5.CrossRefGoogle Scholar
Connolly B, et al. Influence of arm movement on central tip location of peripherally inserted central catheters (PICCS). Pediatr Radiol. 2006;36:845–50.CrossRefGoogle Scholar
Gibson F, Bodenham A. Misplaced central catheters: applied anatomy and practical management. Br J Anesth. 2013;110:333–46. Detailed discussion of central venous anatomy, and anatomical variants causing central line misplacement.CrossRefGoogle Scholar
Gnannt R, et al. Variables decreasing tip movement of peripherally inserted central catheters in pediatric patients. Pediatr Radiol. 2016;46:1532–8.CrossRefGoogle Scholar
Lamperti M, et al. International evidence-based recommendations on ultrasound-guided vascular access. Intensive Care Med. 2012;37:1105–17.CrossRefGoogle Scholar
Menendez JJ, et al. Incidence and risk factors of superficial and deep vein thrombosis associated with peripherally inserted central catheters in children. J Thromb Haemost. 2016;14:2158–68.CrossRefGoogle Scholar
Schindler E, et al. Ultrasound for vascular access in pediatric patients. Pediatr Anesth. 2012;22:1002–7.CrossRefGoogle Scholar
Sharp R, et al. The catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter (PICC): a prospective cohort study. Int J Nurs Stud. 2015;52:677–85.CrossRefGoogle Scholar
Souza Neto EP, et al. Ultrasonographic anatomic variations of the major veins in paediatric patients. Br J Anaesth. 2014;112:879–84.CrossRefGoogle Scholar
Troianos CA, et al. Guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr. 2011;24:1291–318.CrossRefGoogle Scholar