Traditional Long-Term Central Venous Catheters Versus Transhepatic Venous Catheters in Infants and Young Children

Marshall, Amanda M.; Danford, David A.; Curzon, Christopher L.; Anderson, Venus; Delaney, Jeffrey W.

doi:10.1097/pcc.0000000000001276

Cited by 7 publications

(4 citation statements)

References 17 publications

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“…Comparisons between umbilical catheters, PICCs, tunneled CVADs, and nontunneled CVADs based on dwell time, occlusion, thrombosis, and infection risk were the primary focus of the included studies. 15,31,35,88 Generally, short-term peripheral and nonperipheral compatible therapy delivered via umbilical catheters in infants can be used. 66 PICCs were recommended for patients with congenital cardiac conditions requiring $7 days of IV therapy.…”

Section: Congenital Cardiac Conditionsmentioning

confidence: 99%

Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review

et al. 2020

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OBJECTIVE: To critically review the evidence for the selection and insertion of pediatric vascular access devices (VADs). DATA SOURCES: Data were sourced from the US National Library of Medicine, Cumulative Index to Nursing and Allied Health, the Cochrane Library databases, Embase, and international clinical trial databases. STUDY SELECTION: Clinical practice guidelines, systematic reviews, cohort designs, randomized control trials (RCTs), quasi RCTs, before-after trials, or case-control studies that reported on complications and/or risk as well as reliability of VADs in patients aged 0 to 18 years were included. DATA EXTRACTION: Articles were independently reviewed to extract and summarize details on the number of patients and catheters, population, age of participants, VAD type, study method, indication, comparators, and the frequency of VAD failure or complications. RESULTS: VAD selection and insertion decision-making in general hospitalized and some specialized patient populations were well evidenced. The use of single-lumen devices and ultrasound-guided techniques was also broadly supported. There was a lack of RCTs, and for neonates, cardiac patients, patients with difficult venous access, midline catheters, catheter-tovein ratio, and near-infrared devices, the lack of evidence necessitated broadening the review scope. LIMITATIONS: Limitations include the lack of formal assessment of the quality of evidence and the lack of RCTs and systematic reviews. Consequently, clinical decision-making in certain pediatric populations is not guided by strong, evidence-based recommendations. CONCLUSIONS: This is the first synthesis of available evidence for the selection and insertion of VADs in pediatric patients and is important for determining the appropriateness of VADs in pediatric patients. WHAT'S KNOWN ON THIS SUBJECT: Individual studies, systematic reviews, and focused clinical practice guidelines that evaluate vascular access devices (VADs) in various pediatric populations are available. However, to date, no systematic review examining the appropriateness, and inappropriateness, of VADs across common pediatric clinical scenarios exists. WHAT THIS STUDY ADDS: There is strong evidence to support and facilitate appropriate clinical decision-making in some pediatric indications. However, certain populations, device types and characteristics, and insertion procedures are poorly evidenced, necessitating the application of clinical judgment for VAD decision-making.

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Section: Congenital Cardiac Conditionsmentioning

confidence: 99%

Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review

et al. 2020

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“…The feasibility of these alternative routes of access have been previously reported in patients with congenital heart disease. Utilization of transhepatic catheters may be associated with increased rates of complications, such as thrombus formation, catheter dislodgement, and infection, in comparison to traditional catheter routes; however, no long-term complications or increase in infection-related catheter removal have been found [13][14][15][16][17]. Thus, consideration of these alternative access devices and approaches should be considered, though reserved for children with limited availability of other sites [2].…”

Section: Discussionmentioning

confidence: 99%

“…Utilisation of trans-hepatic catheters may be associated with increased rates of complications, such as thrombus formation, catheter dislodgement, and infection, in comparison to traditional catheter routes; however, no long-term complications or increase in infectionrelated catheter removal have been found. [14][15][16][17][18] Thus, consideration of these alternative access devices and approaches should be considered, though reserved for children with limited availability of other sites. 2 Vessel visualisation with ultrasound should be employed whenever achievable to minimise vessel trauma and the number of access attempts.…”

Section: Discussionmentioning

confidence: 99%

The Michigan Appropriateness Guide for Intravenous Catheters in children with congenital heart disease: miniMAGIC-CHD

et al. 2021

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Background: The approach to vascular access in children with CHD is a complex decision-making process that may have long-term implications. To date, evidence-based recommendations have not been established to inform this process. Methods: The RAND/UCLA Appropriateness Method was used to develop miniMAGIC, including sequential phases: definition of scope and key terms; information synthesis and literature review; expert multidisciplinary panel selection and engagement; case scenario development; and appropriateness ratings by expert panel via two rounds. Specific recommendations were made for children with CHD. Results: Recommendations were established for the appropriateness of the selection, characteristics, and insertion technique of intravenous catheters in children with CHD with both univentricular and biventricular physiology. Conclusion: miniMAGIC-CHD provides evidence-based criteria for intravenous catheter selection for children with CHD.

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“…They found that the transhepatic venous lines had superior duration of service without increased thrombosis, thrombolytic use, or insertion site complications relative to central venous lines despite a higher infection rate. 49…”

Section: Access Through Unusual Veinsmentioning

confidence: 99%

Current Management of Difficult Central Venous Access in Pediatric Patients

Chaochankit

Sangkhathat

2019

J Health Sci Med Res

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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.

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Traditional Long-Term Central Venous Catheters Versus Transhepatic Venous Catheters in Infants and Young Children

Cited by 7 publications

References 17 publications

Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review

Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review

The Michigan Appropriateness Guide for Intravenous Catheters in children with congenital heart disease: miniMAGIC-CHD

Current Management of Difficult Central Venous Access in Pediatric Patients

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