The placement of
central venous catheters is often necessary to facilitate optimal anaesthetic and perioperative management or for the long-term management of chronic underlying diseases. Insertion may be a challenge in selected patients, and the risk of
infection,
thrombosis, and other complications may result in significant risk factors.
RECENT FINDINGS: Ultrasound visualization of the cervical veins with Valsalva manoeuvres significantly increases the rate and safety of central venous cannulation, and decreases needle passes in paediatric patients even with experienced operators.
Pericardial effusion with tamponade is a more frequent phenomenon than generally realized, and accurate location of the
catheter-tip position is essential. The femoral venous approach has proved to be safe even in premature babies. Clear guidelines for infection control and the prevention of intravascular
catheter-related infections in children have been established; however, the high incidence of nosocomial
catheter-related infections requires effective prevention strategies. The impact of antimicrobial-impregnated
central venous catheters on the prevention of
bloodstream infections in children is not yet clear. Routine use of prophylactic antibiosis (i.e.
vancomycin) to prevent
catheter-related infection cannot be recommended.
Thrombolytic therapy with recombinant
tissue plasminogen activator is safe, efficient, well tolerated and effective for lysis of
catheter-induced intravascular and intracardiac thrombi even in neonates. Embolized
catheter fragments can be retrieved in neonates and children by non-surgical interventions using standard procedures applied by paediatric cardiologists.
SUMMARY: