title: Transhepatic Broviac catheter placement for long-term central venous access in critically ill children with complex congenital heart disease.
abstract: OBJECTIVE
  Critically ill children with cardiac disease often require prolonged central venous access. Thrombosis of systemic veins or the need to preserve vessels for future cardiac procedures limits sites for placement of central venous catheters in these patients. This study evaluates the use of Broviac placement via the transhepatic approach for this patient population.
  
  
  METHODS
  A retrospective review.
  
  
  METHODS
  A tertiary care center.
  
  
  METHODS
  All children with complex congenital heart disease who underwent transhepatic Broviac placement between May 2000 and April 2004.
  
  
  METHODS
  Transhepatic Broviac placement.
  
  
  RESULTS
  Thirty-two children with a median age of 5 months (20 days-5.3 yrs) and a median weight of 4.2 kg (2.2-24.9 kg) underwent 40 transhepatic Broviac placements. There were three (8.8%) procedural-related complications. One patient suffered an intra-abdominal bleed requiring an urgent laparotomy and removal of the Broviac, one patient required transfusion because of a mild self-contained intra-abdominal bleed, and one patient developed temporary complete heart block. There was one catheter infection. Thrombus was noted by echocardiography on the tip of two Broviacs; however, no intracardiac vegetations or embolic events occurred. There was no mortality related to the procedure. Broviacs remained in place for a median of 36 days (1 day-6 months). Five Broviacs were dislodged inadvertently (two during cardiac massage and three resulting from patient manipulation). The remaining Broviacs were electively removed safely without coil embolization. At a median follow-up of 3.5 months (10 days-3 yrs), there have been no long-term complications related to the Broviacs.
  
  
  CONCLUSIONS
  Transhepatic Broviac catheters can be used safely in critically ill children with cardiac disease and remain indwelling for adequate periods of time. This modality of prolonged vascular access should be considered for children whose veins are occluded or need to be preserved for future procedures.
authors.affiliation: Department of Pediatric and Congenital Heart Disease, The Children's Hospital at the Cleveland Clinic, Cleveland, OH, USA. quresha@ccf.org
authors.forename: Athar M
authors.initials: AM
authors.lastname: Qureshi
authors.forename: John F
authors.initials: JF
authors.lastname: Rhodes
authors.forename: Elumulai
authors.initials: E
authors.lastname: Appachi
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Mumtaz
authors.forename: Brian W
authors.initials: BW
authors.lastname: Duncan
authors.forename: Jeremy
authors.initials: J
authors.lastname: Asnes
authors.forename: Penny
authors.initials: P
authors.lastname: Radavansky
authors.forename: Larry A
authors.initials: LA
authors.lastname: Latson
mesh_terms: D002405:Catheterization, Central Venous / Q000379:methods*; D002408:Catheters, Indwelling; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D006330:Heart Defects, Congenital / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors