Central venous catheters in children and neonates - what is important?

Abstract

Central venous access is an essential part of perioperative management for infants and children undergoing cardiac surgery for congenital heart disease. In addition, a thorough knowledge of the techniues for cannulation and placement of venous lines from the various percutaneously accessible sites is an important aspect of cardiac catheterization in this patient population. In the first of a series of papers describing the various approaches to venous access, we describe percutaneous cannulation of the subclavian vein. The standard approach, as well as potential difficulties, and how to overcome them, are described, as also the complications associated with this approach.

Keywords: Catheterization, Central Venous/adverse effects/*methods; Subclavian Vein; Venous Thrombosis/*prevention & control.

Figures

Fig. 1

Sterile preparation

Fig. 2

Landmarks for subclavian puncture. Yellow circles indicate puncture sites.

Fig. 3

Positioning of the infant

Fig. 4

Trendelenburg position

Fig. 5

Drapes and palpation. A) finger in the sternal notch; B) finger on the clavicle

Fig. 6

Puncture.

Fig. 7

Incision

Fig. 8

Dilator over guidewire

Fig. 9

Catheter advancement

Fig. 10

Fixation