Central venous catheters in children and neonates (Part 2) - Access via the internal jugular vein.

Central venous access via the internal jugular vein (IJV) is safe, relatively easy and very commonly used in infants and children undergoing cardiac surgery for congenital heart disease. Because of the wide range of anatomical variations an ultrasound-guided technique is advantageous in many cases, in particular in patients who have had previous punctures or those in whom difficulties are anticipated for various reasons. The right internal jugular vein is the preferred vein for central venous access as it offers straight access to the superior vena cava. The rate of complications - insertion-related as well as long term - are lower compared to the femoral and the subclavian access.

Central venous catheters in children and neonates (Part 3) - Access via the femoral vein.

BACKGROUND: Central venous access via the femoral vein (FV) is safe, relatively easy and very usual in infants and children undergoing cardiac surgery for congenital heart disease. It has a low insertion-related complication rate. RESULTS: It is therefore a good choice for short-term central venous lines and a preferred insertion site for less experienced staff. The maintenance-related complications of thrombus formation and infections are higher compared to the internal jugular and the subclavian venous access. CONCLUSIONS: Some of these complications are reduced by the use of heparin bonded catheters, routine use of antibiotics, and timely removal of these lines in patients with persistent signs of infection but without another focus being defined.

Central venous catheters in children and neonates - what is important?

Central venous access is an essential part of perioperative management for infants and children undergoing cardiac surgery for congenital heart disease. In addition, a thorough knowledge of the techniues for cannulation and placement of venous lines from the various percutaneously accessible sites is an important aspect of cardiac catheterization in this patient population. In the first of a series of papers describing the various approaches to venous access, we describe percutaneous cannulation of the subclavian vein. The standard approach, as well as potential difficulties, and how to overcome them, are described, as also the complications associated with this approach.