Minimizing complications associated with percutaneous central venous catheter placement in children: recent advances.

OBJECTIVES: To summarize existing knowledge regarding the prevalence of complications associated with temporary percutaneous central venous catheters placed in critically ill children, and to review evolving strategies to minimize the prevalence of these complications. DATA SOURCES: Literature review was performed: PubMed and EBSCOhost were searched using the terms central venous catheter, children, ultrasound, infection, thrombosis, and thromboembolism in various combinations. Citations of interest from identified articles were also reviewed. STUDY SELECTION: The review focused primarily on pediatric literature relevant to the topic of interest. DATA EXTRACTION AND SYNTHESIS: Randomized clinical trials and other prospective studies were discussed in greater detail than retrospective, single-center investigations.
CONCLUSIONS: Complications during percutaneous central venous catheter placement in children are not rare and may be in part attributable to abnormalities in vascular anatomy. Thromboses in children with central venous catheters are increasingly recognized as an important problem for which evidence-based preventive measures are lacking. Catheter-associated bloodstream infection rates in critically ill children have markedly decreased over the last decade, associated with an increased emphasis on staff education and the use of insertion and maintenance bundles. Available evidence tends to support the use of two-dimensional ultrasound to augment the landmark technique for catheter placement, but more studies are needed.