Vascular Access in Infants and Children

Abstract

There has been a significant increase in the survival rates of newborns and infants over the past decade, which is due in large part to advances in monitoring, vascular access, and other supportive measures. The use of new routes of access coupled with innovations in materials and catheter size has led to improvements in invasive monitoring, inotropic support, and the ability to provide total parental nutrition. Arterial cannulation is generally utilized for continuous blood pressure monitoring and frequent blood draws for laboratory studies. Sites of access in the newborn include the radial and pedal arteries as well as the umbilical arteries depending on size and age of the patient. Other sites are generally reserved for emergent situations. Common complications involve vasospasm or thromboembolic events, generally treated by simple removal of the catheter, with infection extremely rare. Venous cannulation remains the most common access method with central catheters placed for vasoactive medication infusion and parenteral nutrition. The umbilical vein can be utilized in the short term. The advent of the peripherally inserted central catheter (PICC) now allows for bedside catheterization of infants as small as 500 g. Percutaneous and cut-down techniques are still utilized in neonates where a PICC line is unable to be obtained or definitive long-term central access is required. In emergency situations such as trauma, an intraosseous device can be placed in the proximal tibia or humerus to provide quick, short-term central venous access. As new materials and techniques continue to evolve, reliable vascular access will allow for the management of even the smallest and most critically ill neonates.