Current Management of Difficult Central Venous Access in Pediatric Patients
DOI:
https://doi.org/10.31584/jhsmr.201937Keywords:
catheter-related thrombosis, central venous catheter, end-stage venous accessAbstract
The central venous catheter (CVC) has become an integral part of various long term parenteral therapies including chemotherapy and parenteral nutrition. In pediatric patients with a long term CVC, multiple repeated accesses and catheter-related complications may lead to difficulty in reestablishment of a line. Strategies in CVC management in these patients should begin with choosing an appropriate catheter according to its purpose, choosing the right access site and prompt treatment of potential complications, especially catheter-related thrombosis. In patients with severe restriction of the superior vena cava and its tributaries, end-stage central venous access is diagnosed. Management of this situation requires a multidisciplinary team and alternative routes of venous access including access through small collateral veins, or through an unusual vein such as the hepatic vein or a gonadal vein, and/or use of alternative surgical techniques. This article provides a comprehensive review regarding the current approach and surgical options in pediatric patients with end-stage central venous access.
References
1. Stovroff M, Teague WG. Intravenous access in infants and children. Pediatr Clin North Am 1998;45:1373-93.
2. Wesley JR. Permanent central venous access devices. Semin Pediatr Surg 1992;1:188-201.
3. Scott-Warren VL, Morley RB. Paediatric vascular access. BJA Education 2015;15:199-206.
4. Faraj W, Zahal A, El-Beyrouthy O, Kutoubi A. Complete catheter disconnection and migration of an implantable
venous access device: the disconnected cap sign. Ann Vasc Surge 2010;24:11-692.e11-5
5. Zaghal A, Khalife M, Mukherji D, EI Majzoub N, Shamseddine A, Hoballah J, et al. Update on totally implantable venous access devices. Surg Oncol 2012;21:207-15.
6. Mughal MM. Complications of intravenous feeding catheters. Br J Surg 1989;76:15-21.
7. Saleh HM, Abdelaziz AS, Hefnawy E, Mansour O. Alternate routes for children with difficult central venous access. Acta Chir Belg 2008;108:563-8.
8. Rupp SM, Apfelbaum JL, Blitt C, Caplan RA, Connis RT, Domino KB, et al. Practice guidelines for central venous access. Anesthesiology 2012;116:539-73.
9. Othersen HB Jr, Hebra HA, Chessman KH. Central lines in parenteral nutrition. In: Pediatric parenteral nutrition. New York: Chapman & Hall; 1997;p.254-71.
10. Rodrigues AF, van Mourik ID, Sharif K, Barron DJ, de Giovanni JV, Bennett J, et al. Management of end-stage central venous access in children referred for possible small bowel transplantation. J Pediatr Gastroenterol Nutr 2006;42:427-33.
11. Mestrovic J, Kovacevic T, Ercegovic I, Polic B, Stricevic L, Omazic A, et al. Use of central venous catheter in children. Signa Vitae 2006;1:20-4.
12. Lorenz JM. Unconventional venous access techniques. Semin Intervent Radiol 2006;23:279-86.
13. Malt RA, Kempster M. Direct azygos vein and superior vena cava cannulation for parenteral nutrition. JPEN J Parenter Enteral Nutr 1983;7:580-1.
14. Donahoe PK, Kim SH. The inferior epigastric vein as an alternate site for central venous hyperalimentation. J Pediatr Surg 1980;15:737-8.
15. Oram-smith JC, Mullen JL, Harken AH, Fitts WTJR. Direct right atrial catheterization for total parenteral nutrition. Surgery 1978;83:274-6.
16. OpenStax College. Anatomy & physiology [monograph on the Internet]. Texas: OpenStax College, Rice University; 2013 [cited 2017 May 20]. Available from: https://cnx.org/content/col11496/1.6/
17. Hamzeh RK, Donan S, Shah S, Levi DS, Moore JW. “Wiretarget” technique for precise vascular access. Tex Heart Inst J 2009;36:321-6.
18. Carlo ID, Biffi R, Niederhuber J. Totally implantable venous access devices management in mid- and long-term clinical setting. New York: Springer; 2011.
19. O’Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, et al. Guidelines for the prevention of intravascular catheter-related infections. Centers for disease control and prevention. MMWR Recomm Rep 2002;51:1-29.
20. Kock HJ, Pietsh M, Krause U, Wilke H, Eigler FW. Implantable vascular access systems: experience in 1,500 patients with totally implanted central venous port systems. World J Surg 1998;22:12-6.
21. Maki DG KD, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clinic Proc 2006;81:1159-71.
22. Garnacho-Montero J, Aldabo-Pallas T, Palomar-Martınez M, Valles J, Almirante B, Garces R, et al. Risk factors and prognosis of catheter-related bloodstream infection in critically ill patients: a multicenter study. Intensive Care Med 2008;34:2185-93.
23. Deshpande KS, Hatem C, Ulrich HL, Currie BP, Aldrich TK, Bryan-Brown CW, et al. The incidence of infectious complications of central venous catheters at the subclavian, internal jugular, and femoral sites in an intensive care unit population. Crit Care Med 2005;33:13-20.
24. East D, Jocoby K. The effect of a nursing staff education program on compliance with central line care policy in the cardiac intensive care unit. Pediatr Nurs 2005;31:182-4.
25. Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Eng J Med 2006;355:2725-32.
26. Mimoz O, Villeminey S, Ragot S, Dahyot-Fizelier C, Laksiri L, Petitpas F, et al. Chlorhexidine-based antiseptic solution vs alcohol-based povidone–iodine for central venous catheter care. Arch Intern Med 2007;167:2066-72.
27. Journeycake JM, Buchanan GR. Thrombotic complications of central venous catheters in children. Curr Opin Hematol 2003;10:369-74.
28. Machado JD, Suen VM, Figueiredo JF, Marchini JS. Biofilms, infection, and parenteral nutrition therapy. JPEN J Parenter Enteral Nutr 2009;33:397-403.
29. Starkhammar H, Bengtsson M, Morales O. Fibrin sleeve formation after long term brachial catheterisation with an implantable port device. A prospective venographic study. Eur J Surg 1992;158:481-4.
30. Timoney JP, Malkin MG, Leone DM, Groeger JS, Heaney ML, Keefe DL, et al. Safe and cost effective use of alteplase for the clearance of occluded central venous access devices. J Clin Oncol 2002;20:1918-22.
31. Whigham CJ, Lindsey JI, Goodman CJ, Fisher RG. Venous port salvage utilizing low dose tPA. Cardiovasc Intervent Radiol 2002;25:513-6.
32. Kingdon EJ, Holt SG, Davar J, Pennell D, Bailod RA, Burns A, et al. Atrial, thrombus, and central venous dialysis catheters. Am J Kidney Dis 2001;38:631-9.
33. Kroger K, Grutte R, Rudofsky G, Fink H, Niebel W. Followup after port-a-cath-induced thrombosis. J Clin Oncol 2002;20:2605-6.
34. Chen CY, Liu CC, Sun WZ. Evidence-based review on catheter-related thrombosis of the implantable venous access device. Tzu Chi Med J 2007;19:207-19.
35. Selvaggi G, Gyamifi A, Kato T, Gelman B, Aggarwal S, Begliomini B, et al. Analysis of vascular access in intestinal transplant recipients using the Miami classification from the VIIIth International Small Bowel Transplant Symposium. Transplantation 2005;79:1639-43.
36. Kaufman SS, Atkison JB, Bianchi A, Goulet OJ, Grant D,Langnas AN, et al. Indications for pediatric intestinal transplantation: a position paper of the American Society of Transplantation. Pediatr Transplant 2001;5:80-7.
37. Galloway S, Bodenham A. Long-term central venous access. Br J Anesth 2004;92:722-34.
38. Gupte GL, Protheroes S, McKiernan P, Murphy S, Booth I, Kelly D, et al. Improvements in outcome of chronic intestinal failure in the UK 1989-2002. J Paediatr Gastroenterol Hepatol Nutr 2004;39:40.
39. Mulvihill SJ, Fonkalsrud EW. Complications of superior versus inferior vena cava occlusion in infants receiving central total parenteral nutrition. J Pediatr Surg 1984;19:752.
40. Qanadli SD, Mesurolle B, Sissakian JF, Chagnon S, Lacombe P, et al. Implanted central venous catheter-related acute superior vena cava syndrome: management by metallic stent and endovascular repositioning of the catheter tip.
Eur Radiol 2000;10:1329-31.
41. de Buys roessingh AS, portier-Marret N, Terciera S, Qanadli SD, Joseph JM. Qanadlib, Jean-Marc Josepha. Combined endovascular and surgical recanalization after central venous catheter-related obstructions. J Pediatric Surg 2008;43:E21-4.
42. Pokorny WJ, McGil CW, Haberg FJ. The use of the azygos vein for central catheter insertion. Surgery 1985;97:362.
43. Newman BM, Cooney DR, Karp MP, Jewett TC JR. The intercostal vein: an alternate route for central venous alimentation. J Pediatr Surg 1983;18:732-3.
44. Cronen PW, Brown G, Crowley R. Use of an intercostal and azygos vein for central hyperalimentation. JPEN J Parenter Enteral Nutr 1984;8:590.
45. Azizkhan RG, Taylor LA, Jaques PF, Mauro MA, Lacey SR. Percutaneous translumbar and transhepatic inferior vena caval catheters for prolonged vascular access in children. J Pediatr Surg 1992;19:165-9.
46. Chang MY, Morris JB. Long-term central venous access through the ovarian vein. J Parent Ent Nutr 1997;21:235-7.
47. Smith TP, Ryan JM, Reddan DN. Transhepatic catheter access for hemodialysis. Radiology 2004;232:246-51.
48. Boe BA, Zampi JD, Yu S, Donohue JE, Aiyagarri R. Transhepatic central venous catheters in pediatric patients with congenital heart disease. Pediatr Crit Care Med 2015;16:726-32.
49. Marshall AM, Danford DA, Curzon CL, Anderson V, Delaney JW. Traditional long-term central venous catheters versus transhepatic venous catheters in infants and young children. Pediatr Crit Care Med 2017;18:944-8.
50. Versleijen MW, Huisman-de-waal GJ, Kock MC, Elferink AJ, van Rossum LG, Feuth T, et al. Arteriovenous fistulae as an alternative to central venous catheters for delivery of long-term home parenteral nutrition. Gastroenterology 2009;136:1577-84.
51. Chand DH, Valentini RP, Kamil ES. Hemodialysis vascular access options in pediatrics: considerations for patients and practitioners. Pediatr Nephrol 2009;24:1121-8.
52. McCarthy WJ, Valentino LA, Bonilla AS, Goncharova I, Taylor A, Pooley TA, et al. Arteriovenous fistula for long-term venous access for boys with hemophilia. J Vasc Surg 2007;45:986-90.
2. Wesley JR. Permanent central venous access devices. Semin Pediatr Surg 1992;1:188-201.
3. Scott-Warren VL, Morley RB. Paediatric vascular access. BJA Education 2015;15:199-206.
4. Faraj W, Zahal A, El-Beyrouthy O, Kutoubi A. Complete catheter disconnection and migration of an implantable
venous access device: the disconnected cap sign. Ann Vasc Surge 2010;24:11-692.e11-5
5. Zaghal A, Khalife M, Mukherji D, EI Majzoub N, Shamseddine A, Hoballah J, et al. Update on totally implantable venous access devices. Surg Oncol 2012;21:207-15.
6. Mughal MM. Complications of intravenous feeding catheters. Br J Surg 1989;76:15-21.
7. Saleh HM, Abdelaziz AS, Hefnawy E, Mansour O. Alternate routes for children with difficult central venous access. Acta Chir Belg 2008;108:563-8.
8. Rupp SM, Apfelbaum JL, Blitt C, Caplan RA, Connis RT, Domino KB, et al. Practice guidelines for central venous access. Anesthesiology 2012;116:539-73.
9. Othersen HB Jr, Hebra HA, Chessman KH. Central lines in parenteral nutrition. In: Pediatric parenteral nutrition. New York: Chapman & Hall; 1997;p.254-71.
10. Rodrigues AF, van Mourik ID, Sharif K, Barron DJ, de Giovanni JV, Bennett J, et al. Management of end-stage central venous access in children referred for possible small bowel transplantation. J Pediatr Gastroenterol Nutr 2006;42:427-33.
11. Mestrovic J, Kovacevic T, Ercegovic I, Polic B, Stricevic L, Omazic A, et al. Use of central venous catheter in children. Signa Vitae 2006;1:20-4.
12. Lorenz JM. Unconventional venous access techniques. Semin Intervent Radiol 2006;23:279-86.
13. Malt RA, Kempster M. Direct azygos vein and superior vena cava cannulation for parenteral nutrition. JPEN J Parenter Enteral Nutr 1983;7:580-1.
14. Donahoe PK, Kim SH. The inferior epigastric vein as an alternate site for central venous hyperalimentation. J Pediatr Surg 1980;15:737-8.
15. Oram-smith JC, Mullen JL, Harken AH, Fitts WTJR. Direct right atrial catheterization for total parenteral nutrition. Surgery 1978;83:274-6.
16. OpenStax College. Anatomy & physiology [monograph on the Internet]. Texas: OpenStax College, Rice University; 2013 [cited 2017 May 20]. Available from: https://cnx.org/content/col11496/1.6/
17. Hamzeh RK, Donan S, Shah S, Levi DS, Moore JW. “Wiretarget” technique for precise vascular access. Tex Heart Inst J 2009;36:321-6.
18. Carlo ID, Biffi R, Niederhuber J. Totally implantable venous access devices management in mid- and long-term clinical setting. New York: Springer; 2011.
19. O’Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, et al. Guidelines for the prevention of intravascular catheter-related infections. Centers for disease control and prevention. MMWR Recomm Rep 2002;51:1-29.
20. Kock HJ, Pietsh M, Krause U, Wilke H, Eigler FW. Implantable vascular access systems: experience in 1,500 patients with totally implanted central venous port systems. World J Surg 1998;22:12-6.
21. Maki DG KD, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clinic Proc 2006;81:1159-71.
22. Garnacho-Montero J, Aldabo-Pallas T, Palomar-Martınez M, Valles J, Almirante B, Garces R, et al. Risk factors and prognosis of catheter-related bloodstream infection in critically ill patients: a multicenter study. Intensive Care Med 2008;34:2185-93.
23. Deshpande KS, Hatem C, Ulrich HL, Currie BP, Aldrich TK, Bryan-Brown CW, et al. The incidence of infectious complications of central venous catheters at the subclavian, internal jugular, and femoral sites in an intensive care unit population. Crit Care Med 2005;33:13-20.
24. East D, Jocoby K. The effect of a nursing staff education program on compliance with central line care policy in the cardiac intensive care unit. Pediatr Nurs 2005;31:182-4.
25. Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Eng J Med 2006;355:2725-32.
26. Mimoz O, Villeminey S, Ragot S, Dahyot-Fizelier C, Laksiri L, Petitpas F, et al. Chlorhexidine-based antiseptic solution vs alcohol-based povidone–iodine for central venous catheter care. Arch Intern Med 2007;167:2066-72.
27. Journeycake JM, Buchanan GR. Thrombotic complications of central venous catheters in children. Curr Opin Hematol 2003;10:369-74.
28. Machado JD, Suen VM, Figueiredo JF, Marchini JS. Biofilms, infection, and parenteral nutrition therapy. JPEN J Parenter Enteral Nutr 2009;33:397-403.
29. Starkhammar H, Bengtsson M, Morales O. Fibrin sleeve formation after long term brachial catheterisation with an implantable port device. A prospective venographic study. Eur J Surg 1992;158:481-4.
30. Timoney JP, Malkin MG, Leone DM, Groeger JS, Heaney ML, Keefe DL, et al. Safe and cost effective use of alteplase for the clearance of occluded central venous access devices. J Clin Oncol 2002;20:1918-22.
31. Whigham CJ, Lindsey JI, Goodman CJ, Fisher RG. Venous port salvage utilizing low dose tPA. Cardiovasc Intervent Radiol 2002;25:513-6.
32. Kingdon EJ, Holt SG, Davar J, Pennell D, Bailod RA, Burns A, et al. Atrial, thrombus, and central venous dialysis catheters. Am J Kidney Dis 2001;38:631-9.
33. Kroger K, Grutte R, Rudofsky G, Fink H, Niebel W. Followup after port-a-cath-induced thrombosis. J Clin Oncol 2002;20:2605-6.
34. Chen CY, Liu CC, Sun WZ. Evidence-based review on catheter-related thrombosis of the implantable venous access device. Tzu Chi Med J 2007;19:207-19.
35. Selvaggi G, Gyamifi A, Kato T, Gelman B, Aggarwal S, Begliomini B, et al. Analysis of vascular access in intestinal transplant recipients using the Miami classification from the VIIIth International Small Bowel Transplant Symposium. Transplantation 2005;79:1639-43.
36. Kaufman SS, Atkison JB, Bianchi A, Goulet OJ, Grant D,Langnas AN, et al. Indications for pediatric intestinal transplantation: a position paper of the American Society of Transplantation. Pediatr Transplant 2001;5:80-7.
37. Galloway S, Bodenham A. Long-term central venous access. Br J Anesth 2004;92:722-34.
38. Gupte GL, Protheroes S, McKiernan P, Murphy S, Booth I, Kelly D, et al. Improvements in outcome of chronic intestinal failure in the UK 1989-2002. J Paediatr Gastroenterol Hepatol Nutr 2004;39:40.
39. Mulvihill SJ, Fonkalsrud EW. Complications of superior versus inferior vena cava occlusion in infants receiving central total parenteral nutrition. J Pediatr Surg 1984;19:752.
40. Qanadli SD, Mesurolle B, Sissakian JF, Chagnon S, Lacombe P, et al. Implanted central venous catheter-related acute superior vena cava syndrome: management by metallic stent and endovascular repositioning of the catheter tip.
Eur Radiol 2000;10:1329-31.
41. de Buys roessingh AS, portier-Marret N, Terciera S, Qanadli SD, Joseph JM. Qanadlib, Jean-Marc Josepha. Combined endovascular and surgical recanalization after central venous catheter-related obstructions. J Pediatric Surg 2008;43:E21-4.
42. Pokorny WJ, McGil CW, Haberg FJ. The use of the azygos vein for central catheter insertion. Surgery 1985;97:362.
43. Newman BM, Cooney DR, Karp MP, Jewett TC JR. The intercostal vein: an alternate route for central venous alimentation. J Pediatr Surg 1983;18:732-3.
44. Cronen PW, Brown G, Crowley R. Use of an intercostal and azygos vein for central hyperalimentation. JPEN J Parenter Enteral Nutr 1984;8:590.
45. Azizkhan RG, Taylor LA, Jaques PF, Mauro MA, Lacey SR. Percutaneous translumbar and transhepatic inferior vena caval catheters for prolonged vascular access in children. J Pediatr Surg 1992;19:165-9.
46. Chang MY, Morris JB. Long-term central venous access through the ovarian vein. J Parent Ent Nutr 1997;21:235-7.
47. Smith TP, Ryan JM, Reddan DN. Transhepatic catheter access for hemodialysis. Radiology 2004;232:246-51.
48. Boe BA, Zampi JD, Yu S, Donohue JE, Aiyagarri R. Transhepatic central venous catheters in pediatric patients with congenital heart disease. Pediatr Crit Care Med 2015;16:726-32.
49. Marshall AM, Danford DA, Curzon CL, Anderson V, Delaney JW. Traditional long-term central venous catheters versus transhepatic venous catheters in infants and young children. Pediatr Crit Care Med 2017;18:944-8.
50. Versleijen MW, Huisman-de-waal GJ, Kock MC, Elferink AJ, van Rossum LG, Feuth T, et al. Arteriovenous fistulae as an alternative to central venous catheters for delivery of long-term home parenteral nutrition. Gastroenterology 2009;136:1577-84.
51. Chand DH, Valentini RP, Kamil ES. Hemodialysis vascular access options in pediatrics: considerations for patients and practitioners. Pediatr Nephrol 2009;24:1121-8.
52. McCarthy WJ, Valentino LA, Bonilla AS, Goncharova I, Taylor A, Pooley TA, et al. Arteriovenous fistula for long-term venous access for boys with hemophilia. J Vasc Surg 2007;45:986-90.
Downloads
Published
2019-01-15
How to Cite
1.
Sangkhathat S, Chaochankit W. Current Management of Difficult Central Venous Access in Pediatric Patients. J Health Sci Med Res [Internet]. 2019 Jan. 15 [cited 2024 Dec. 23];37(1):67-80. Available from: https://he01.tci-thaijo.org/index.php/jhsmr/article/view/131099
Issue
Section
Review Article
