Pediatric Central Venous Catheters
Central Venous Catheter (CVC)
Introduction
A specialized vascular access device inserted into large central veins for long-term venous access in pediatric patients, crucial for medication administration, fluid therapy, and hemodynamic monitoring.
Technical Specifications
- Catheter Types:
- Non-tunneled CVCs
- Tunneled CVCs (Broviac/Hickman)
- Implanted ports
- PICC lines
- Size Selection:
- Neonates: 2-3 Fr
- Infants: 3-4 Fr
- Toddlers: 4-5 Fr
- School-age: 5-7 Fr
Insertion Sites
- Common Locations:
- Internal jugular vein
- Subclavian vein
- Femoral vein
- Basilic/Brachial veins (PICC)
- Site Selection Factors:
- Patient size and anatomy
- Intended duration of use
- Infection risk considerations
- Coagulation status
Insertion Procedure
- Pre-procedure:
- Coagulation profile assessment
- Ultrasound vessel mapping
- Sterile technique preparation
- Sedation/analgesia planning
- Procedural Steps:
- Maximal barrier precautions
- Real-time ultrasound guidance
- Seldinger technique application
- Position confirmation
- Securement method
Maintenance Protocols
- Daily Care:
- Dressing assessment and change
- Exit site inspection
- Cap/hub changes
- Patency assessment
- Infection Prevention:
- Chlorhexidine skin preparation
- Sterile barrier during procedures
- Regular bioconnector changes
- Hand hygiene protocols
Complications Management
- Immediate Complications:
- Pneumothorax
- Arterial puncture
- Air embolism
- Dysrhythmias
- Malposition
- Late Complications:
- CLABSI (Central Line Associated Bloodstream Infection)
- Thrombosis
- Catheter migration
- Catheter occlusion
- Exit site infection
Monitoring Requirements
- Regular Assessments:
- Site appearance
- Catheter function
- Line necessity evaluation
- Infection surveillance
- Documentation:
- Insertion details
- Daily assessments
- Complications
- Dressing changes
- Line removal
Quality Metrics
- Bundle Compliance:
- Insertion checklist adherence
- Maintenance bundle compliance
- Hand hygiene observations
- CLABSI rates
- Outcome Measures:
- Catheter days
- Infection rates
- Mechanical complications
- Successful insertion rates
