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Tunneling Central Venous Catheters to the Scapular Region in Pediatric Patients with Attention Deficit Disorder and Autism

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Ultrasound Guided Vascular Access

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Abstract

Introduction: Central venous catheter dislodgement is an early complication of intravenous therapy in the pediatric patient population. There are several methods to assist with catheter securement such as wrapping the catheter site, soft wrist restraints when appropriate, direct observation, subcutaneous securement, cyanoacrylate, and suturing. But despite these efforts, patients can still self-remove vascular access devices, if within their reach. The risk of catheter dislodgement is magnified when treating children with autism spectrum disorder due to challenges with communication, repetitive behaviors, sensory issues, and impulsivity. In situations where traditional device stabilization has failed, reports of subcutaneously tunneling the catheter to the scapular region places the catheter out of sight and reach of the patient and has proven to be safe to perform with successful outcomes.

Case Report: The patient was a 2-year-old girl with autism, attention deficit disorder, and speech delay, admitted to the hospital with metastatic hepatoblastoma and thrombocytopenia. She required the removal of her peripherally inserted central catheter (PICC) replacement after developing Klebsiella bacteremia. The infection was related to scratching of the insertion site and surrounding area despite all efforts to wrap and protect this region. In the past year, the patient had removed four prior PICC lines. The mother agreed to placing a port, but the patient required 2 weeks of chemotherapy, daily fluid administration, and antibiotics prior to port placement. The Vascular Access Service was consulted for a tunneled catheter placement to the scapular region as a 2-week bridge until a surgical port could be placed.

Conclusion: In the patient with cognitive or developmental impairments resulting in catheter removal, subcutaneously tunneling the catheter to the scapular region provides a safe, out of reach, noninvasive method for long-term catheter placement in children.

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Author information

Authors and Affiliations

  1. Division of Vascular Access, St. Joseph’s University Health, Paterson, NJ, USA

    Matthew D. Ostroff

  2. Division of Cardiothoracic Surgery, St. Joseph’s University Health, Paterson, NJ, USA

    Mark W. Connolly

Authors
  1. Matthew D. Ostroff
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  2. Mark W. Connolly
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Correspondence to Matthew D. Ostroff .

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Ostroff, M.D., Connolly, M.W. (2022). Tunneling Central Venous Catheters to the Scapular Region in Pediatric Patients with Attention Deficit Disorder and Autism. In: Ultrasound Guided Vascular Access. Springer, Cham. https://doi.org/10.1007/978-3-031-18614-1_40

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  • DOI: https://doi.org/10.1007/978-3-031-18614-1_40

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-18613-4

  • Online ISBN: 978-3-031-18614-1

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