Chapter 47. Pediatric Vascular Access

• Need for acute resuscitation.
  • Trauma.
  • Critical care monitoring.
• Need for long-term central venous access.
  • Total parenteral nutrition.
  • Chemotherapy.
  • Hemodialysis.
  • Long-term antibiotic therapy.
  • Limited peripheral access in ill child.

Absolute

• None.

Relative

• Coagulopathy.
• Severe thrombocytopenia.

• The patient is most often positioned supine with a shoulder roll in place.
• If a saphenous vein cutdown or femoral vein catheterization is planned, the leg should be straight and abducted away from the midline.

• All lines except radial arterial lines require a post-procedure radiograph to confirm catheter position and look for complications.
  • These films may pick up a subtle pneumothorax not seen by fluoroscopy during catheter placement.
• Meticulous aseptic technique must be used for routine catheter care and every time the catheter is accessed for infusion or blood draw.

Acute

• Pneumothorax.
• Hemothorax.
• Catheter malposition.
• Pericardial tamponade.

Chronic

• Catheter infection.
• Bacteremia and line sepsis.
• Catheter thrombosis.
• Vessel thrombosis.
• Septic emboli.
• SVC syndrome.