Central venous catheters are widely used in the care of critically ill patients. This paper reviews our experience with central lines in paediatric patients requiring intensive care, between the period August 1994 and August 1995. A total of 57 insertions were performed in 40 patients, all less than 12 years of age. We found that the most common indication for catheter use was nutritional support (40%). The overall complication rate was 58%. Catheter-related infection was the most serious problem, occurring in 32% of all insertions. Coagulase-negative Staphylococcus aureus was the organism most frequently isolated. Maintenance problems affected 17 of our catheters in which 9 were blocked. Both infected and blocked catheters were promptly removed. We had 3 cases of perforation and 2 cases of thrombosis. There were no deaths directly attributed to catheter use. Recommendations made include: 1) staff education and new guidelines for catheter care, 2) use of bacteria filters, 3) careful prospective monitoring of catheter infection rate, 4) heparinisation when infusion rate less than 2 ml/h, 5) eliminate use of stiff polyethylene catheters and 6) routine confirmatory X-ray or waveform monitoring before catheter use, if possible.We concluded that central venous catheterisations greatly facilitated the management of our patients. However, one must bear in mind that the use of such catheters is associated with problems which must be recognised early and promptly treated and, if possible, prevented with safe practice.
Peripheral access by venous cut down, once popular in the 1950s and 1960s, has almost become obsolete with the introduction of the Seldinger technique for percutaneous insertion of central venous lines. In 1973, Shaw invented a technique of cannulating peripheral veins with silastic catheters, as an alternative approach to central venous lines, mainly for the purpose of parenteral nutrition, which has relatively low morbidity even in very low birth weight (VLBW) infants.
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