Difficult Vascular Access in Children with Short Bowel Syndrome: What to Do Next?

Abstract

Short Bowel Syndrome and intestinal failure are chronic and severe conditions that may require life-long parenteral nutrition in children. Survival of these children rely on the correct functioning of central venous catheters; therefore, careful management, prevention, and treatment of complications is of paramount importance. Despite a growing awareness of preserving the vascular real estate, a certain number of patients still experience a progressive and life-threatening exhaustion of vascular access. We searched the literature to highlight the current management of children with vascular exhaustion, specifically focusing on vascular access salvage strategies and last-resource alternative routes to central veins. Given the paucity of data, results are reported in the form of a narrative review.

Ethanol lock therapy increases mechanical catheter complications in a pediatric intestinal failure population: A retrospective cohort study

“…Most CVCs used in this study were tunneled CVCs, although a small minority of peripherally inserted central catheters (PICCs) were used. PICCs are typically used in the patient with difficult vascular access and placed by interventional radiology preferentially into small extremity veins 17 . PICCs may have an increased risk of venous injury (stenosis or thrombosis) as well as catheter malposition or dislodgement 18 .…”

“…PICCs are typically used in the patient with difficult vascular access and placed by interventional radiology preferentially into small extremity veins. 17 PICCs may have an increased risk of venous injury (stenosis or thrombosis) as well as catheter malposition or dislodgement. 18 Inconsistent and limited literature has investigated the impact of PICCs on CLABSI rates.…”