Percutaneous Central Venous catheterization - Neonatal Disorders

What is Percutaneous Central Venous Catheterization?

Percutaneous central venous catheterization is a medical procedure used to place a central venous catheter (CVC) into a large vein. This procedure is commonly performed in pediatric patients who require long-term intravenous access for medications, nutritional support, or medical monitoring.

Why is it Important in Pediatrics?

In pediatrics, the procedure is particularly important for children with chronic illnesses, those undergoing chemotherapy, or patients in intensive care units. It provides reliable venous access, allowing for the delivery of medication and other treatments that might be too irritating for peripheral veins.

How is the Procedure Performed?

The procedure involves inserting a catheter through the skin into a large vein, typically the internal jugular, subclavian, or femoral vein. The process is guided by ultrasound or fluoroscopy to ensure accurate placement. After insertion, the catheter is advanced until it reaches the superior vena cava, just above the heart.

What are the Indications for Use?

Common indications for percutaneous central venous catheterization in children include the need for total parenteral nutrition, administration of vesicant drugs, frequent blood sampling, and hemodynamic monitoring. It is also used when peripheral venous access is difficult or impossible.

What are the Risks and Complications?

While generally safe, percutaneous central venous catheterization can have risks, including infection, bleeding, pneumothorax, and catheter malposition. Careful technique and use of sterile techniques can minimize these risks. Regular monitoring and maintenance of the catheter are essential to prevent complications.

How to Prepare for the Procedure?

Preparation involves obtaining informed consent, assessing coagulation status, and ensuring the child is appropriately sedated or anesthetized. The procedure area is thoroughly cleaned, and sterile drapes are used to maintain a sterile field.

What Post-Procedural Care is Required?

After catheter placement, it is crucial to confirm the catheter's position via chest X-ray. The catheter site should be regularly inspected for signs of infection or complications. Routine dressing changes and flushes with saline or heparin are performed to maintain patency and prevent clotting.

What are the Alternatives?

Alternatives to percutaneous central venous catheterization include peripherally inserted central catheters (PICC lines) and tunneled central venous catheters. Each alternative has its own set of indications, advantages, and disadvantages.

Conclusion

Percutaneous central venous catheterization is a critical procedure in pediatric medicine, offering reliable and long-term venous access for a variety of medical needs. Understanding the procedure, its indications, risks, and care requirements ensures optimal outcomes for pediatric patients.