Central venous catheter access.

Central venous access for the purpose of supplying parenteral nutrition to the pediatric age group requires a careful definition of the patient's caloric need, estimated duration of therapy, and an assessment of available sites. Peripheral vein parenteral nutrition is limited by caloric density of the nutrient fluids, while peripherally inserted central catheters (PICC) offers a new technology for accessing central veins while obviating the risk of central vein access. Routes of central vein access are several and there are also a variety of catheters available for placement. Tunneled percutaneous placement of silicone rubber cuffed catheters via the subclavian vein approach is that technique we use most commonly. The risks of such access catheters include mechanical risks of placement, venous thrombosis of the access sites, and most importantly catheter related infections, either at the exit site, the subcutaneous tunnel or pouch, or even generalized sepsis. With a full knowledge of the spectrum of access techniques, access materials, and risks, safe total parenteral nutrition can be safely delivered to the children in need.