TY - JOUR
T1 - Central venous catheter use in the pediatric patient
T2 - mechanical and infectious complications
AU - de Jonge, Rogier C J
AU - Polderman, Kees H
AU - Gemke, Reinoud J B J
PY - 2005/5
Y1 - 2005/5
N2 - OBJECTIVE: Following the introduction and widespread use of central venous catheters (CVCs) in adults, these devices are being used with increasing frequency in the pediatric population. This review will focus on differences between adults and children regarding CVC use and its potential complications. Both mechanical and infectious complications will be discussed.DATA SOURCES: Systematic review of the literature.CONCLUSIONS: CVC-related complications in pediatric patients are closely linked to age, body size, and age-related immune status. In older children, many complications are similar to those encountered in adult patients. Because of ongoing growth and body changes, a cutoff point beyond which children can be regarded as "young adults" is difficult to define; many of our recommendations are therefore age-related. More frequently than in adults, an implanted port may be the first choice in pediatric patients when long indwelling times are expected. The optimal site of insertion also depends on factors such as the patients' age as well as the need for sedation and analgesia during the insertion procedure. In contrast to guidelines in adult patients, we recommend that a radiograph always be made following CVC insertion to check the position of the catheter. Regarding prevention of infectious complications, we recommend full sterile barrier precautions during CVC insertion and strict protocols for catheter care. CVCs should be removed as soon as possible when they are no longer needed, but there is no place for elective CVC replacement on a routine basis. New developments such as the use of impregnated catheters might help reduce infection rates; however, additional research will be required to provide more evidence of benefit in the pediatric population.
AB - OBJECTIVE: Following the introduction and widespread use of central venous catheters (CVCs) in adults, these devices are being used with increasing frequency in the pediatric population. This review will focus on differences between adults and children regarding CVC use and its potential complications. Both mechanical and infectious complications will be discussed.DATA SOURCES: Systematic review of the literature.CONCLUSIONS: CVC-related complications in pediatric patients are closely linked to age, body size, and age-related immune status. In older children, many complications are similar to those encountered in adult patients. Because of ongoing growth and body changes, a cutoff point beyond which children can be regarded as "young adults" is difficult to define; many of our recommendations are therefore age-related. More frequently than in adults, an implanted port may be the first choice in pediatric patients when long indwelling times are expected. The optimal site of insertion also depends on factors such as the patients' age as well as the need for sedation and analgesia during the insertion procedure. In contrast to guidelines in adult patients, we recommend that a radiograph always be made following CVC insertion to check the position of the catheter. Regarding prevention of infectious complications, we recommend full sterile barrier precautions during CVC insertion and strict protocols for catheter care. CVCs should be removed as soon as possible when they are no longer needed, but there is no place for elective CVC replacement on a routine basis. New developments such as the use of impregnated catheters might help reduce infection rates; however, additional research will be required to provide more evidence of benefit in the pediatric population.
KW - Adult
KW - Age Factors
KW - Anti-Bacterial Agents/therapeutic use
KW - Bacterial Infections/drug therapy
KW - Body Size
KW - Catheterization, Central Venous/adverse effects
KW - Child
KW - Cross Infection/etiology
KW - Equipment Contamination
KW - Humans
KW - Mycoses/drug therapy
KW - Risk Factors
KW - Thrombosis/etiology
U2 - 10.1097/01.PCC.0000161074.94315.0A
DO - 10.1097/01.PCC.0000161074.94315.0A
M3 - Review article
C2 - 15857534
VL - 6
SP - 329
EP - 339
JO - Pediatric critical care medicine
JF - Pediatric critical care medicine
SN - 1529-7535
IS - 3
ER -