Central Venous Catheters in Small Infants
In this neat editorial, the authors discuss the importance of central venous access in small infants and make suggestions for how we can better understand this challenging area of paediatric anaesthesia.
Key points:
- Increasing numbers of small infants are presenting for central access due to improved survival and requirement for long-term management with drugs, fluids and TPN.
- The pitfalls of PICC access are discussed, with PICC complication or failure leading to requirement for robust central venous access.
- The ongoing evolution of ultrasound technology has led to percutaneous vascular access overtaking surgical ‘cut-down’ techniques to become the standard of care.
- The options for central catheters are non-tunnelled, tunnelled and fully-implanted devices, with the rate of infection highest in non-tunnelled and lowest in implanted lines. The choice of technique is variable between institutions.
- The relatively small population of patients in this cohort and the variety of approaches employed in different centres has led to a paucity of quality outcome data- particularly data relating to global outcomes such as device removal or replacement.
- The authors suggest that a broader view of the issue (i.e. multi-centre studies and international collaboration) will aid in developing a better evidence-based approach for central venous access in small infants.
Reviewed by: Dr Nicholas Hogan, LCCH, Brisbane
