Central Venous Catheter Use in the Pediatric Patient
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.

Following the introduction and widespread use of central venous catheters (CVCs) in adult patients, these devices are now frequently used also in the pediatric population. They have become an indispensable route for venous access, especially in pediatric intensive care units (PICUs). Nowadays, millions of CVCs are used worldwide to monitor hemodynamic status; to administer fluids, medication, and parenteral nutrition; and for blood sampling.

In recent years, a number of reviews have been published dealing with complications of CVC use in the adult population. Most of these reviews have focused mainly on infectious complications, but one article published in 2002 dealt specifically with mechanical complications. However, specific problems associated with central venous access in pediatric patients were not addressed in these articles, and indeed problems in pediatric patients were often explicitly excluded. Although in some aspects pediatric patients may be regarded as little adults, there are many important differences regarding CVC use between adults and children, especially very young children (<8 yrs). These differences will be the main focus of this review.

Newborns represent a separate category of patients with specific problems and sites of venous access that differ from those in older pediatric patients. These issues will not be addressed in this review.