Abstract
Surgically placed central venous catheters (CVC) are increasingly being replaced by percutaneous CVC (PCVC) for nutritional and fluid support of neonates. (Durand, Pediatrics, 1986) We report successful use of the same small silastic PCVC in infants and children aged 2 months to 12 9/12 years with weights between 4.4 and 21 Kilograms. Indications for use included post-operative short bowel syndrome, regional ileitis, intractable diarrhea, and meningitis. Although tiny (internal diameter 0.012 inch, outer diameter 0.025 inch) PCVC accommodated flow rates from 2-90 ml/hr and hyperalimentation fluid with concentrations of 25% Dextrose and 20% Intralipids.
Analgesia was used for the procedure which was performed in the treatment room or the patient's own room. Placement (in the Subclavian vein or Right Atrium) was confirmed by chest x-ray with injection of 0.3cc of Renografin. PCVC remained in place an average of 29 days (range 5-43 days). Difficulty advancing the catheter from peripheral entry site was noted. Complications included occlusion (treated with Urokinase), dislodgement of the catheter and infection.
Conclusion: PCVC is an alternative to surgically placed CVC and does not require ligation of major veins. They can be placed at the bedside, without general anesthesia, operate at high flow rates, with high viscosity fluids, and remain functional for long periods of time.
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Sobel, D., Kecskes, S. SMALL PERCUTANEOUS CENTRAL VENOUS CATHETERS IN INFANTS AND CHILDREN. Pediatr Res 21 (Suppl 4), 278 (1987). https://doi.org/10.1203/00006450-198704010-00664
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DOI: https://doi.org/10.1203/00006450-198704010-00664