Central venous access in children: indications, devices, and risks.
OBJECTIVE
Central venous catheters (CVCs) have a prominent role in the diagnostic and therapy of neonates and children. Herein, we describe the multiple indications for CVC use and the different devices available for central venous access. Given the prevalent use of CVCs, healthcare systems are focused on reducing complications from their use, particularly central line-associated bloodstream infections (CLABSIs). The most up-to-date information available sheds light on best practices and future areas of investigation.


RESULTS
Large systematic reviews of randomized trials suggest that ultrasound guidance for placement of CVCs in children is safer than using blind technique, at least for internal jugular vein access. Appropriate catheter tip placement is associated with decreased complications. Furthermore, the prophylactic use of ethanol lock between cycles of parenteral nutrition administration has reduced the rates of CLABSI. A recent randomized trial in pediatric CVCs showed a benefit with antibiotic-coated CVCs.


CONCLUSIONS
Based on the available evidence, multiple techniques for CVC placement are still valid, including the landmark technique based on practitioner experience, but ultrasound guidance has been shown to decrease complications from line placement. Adherence to CVC care protocols is essential in reducing infectious complications.
Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Guillermo
G
Ares
Catherine J
CJ
Hunter
D055499:Catheter-Related Infections / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D062905:Central Venous Catheters / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004868:Equipment Failure; D005548:Foreign-Body Migration / Q000209:etiology / Q000517:prevention & control; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017410:Practice Guidelines as Topic; D012306:Risk; D018084:Ultrasonography, Interventional