Abstract

Due to small vessel size, obtaining stable access in pediatric patients is difficult. In addition, because needle stick pain is a concern for patients with chronic illness, central venous catheters are often utilized to provide intravenous treatment. Catheter occlusion is a common complication in pediatric patients and must be addressed to salvage the catheter and ensure successful therapy. The use of fibrinolytics for occlusion treatment have been successful in pediatric populations.

Abstract

Central vascular access device (CVAD) care for infants and children in home settings is challenging due to small catheter sizes, patient activity, and variation in care and maintenance practices. CVADs require detailed care to prevent complications and unnecessary line replacement. Guidelines that address CVAD care and maintenance for pediatric home-based patients do not exist. This article reviews evidence-based central venous catheter maintenance practices for pediatric home care patients.

Abstract

Background: The specialty of pediatric vascular access has grown rapidly during the past 5 years across the United States. The majority of children's hospitals have nurse-led vascular access teams that are providing comprehensive services, including the placement of peripherally inserted central catheters. A children's hospital in the southeastern United States conducted an Internal Review Board approved, retrospective analysis of 669 patients who had a peripherally inserted central catheter placed.

Objective: The objective was to have a better understanding of the program and clinical outcomes as well as identify areas for improvement.

Methods: A data collection tool was developed to review the medical records of patients receiving a peripherally inserted central catheter from January 2009 through June 2011. Variables of interest included patient age, admitting diagnosis, intended therapy, procedure location, sedation type and usage, procedure success, insertion attempts, vessel selected, catheter size and type, catheter tip location, reason for discontinuation, and infection. The data was collected and analyzed by a nurse researcher from the University of South Florida.

Results: Using the Modified Seldinger Technique and ultrasound, the team inserted a full line of polyurethane catheters, including computed tomography-injectable catheters, with an insertion success rate of 94%. We identified a significant reduction in our hospital's infection rate—from 9.12 per 1,000 catheter line days to 2.0 per 1,000 catheter line days—during the first year and a half of the program. The use of sedation and anesthesia was significantly reduced, with 49% of patients receiving an oral anxiolytic dose of midazolam and the integration of certified child life specialists into the procedure.

Conclusions: Pediatric vascular access is a rapidly growing specialty in nursing. Nurse-led vascular access teams have become commonplace in children's hospitals throughout the United States. Although the specialty has grown rapidly during the past 5 years, there is a need for data sharing to contribute to the knowledge base of pediatric vascular access.

Abstract

Clinicians placing peripherally inserted central catheters utilize a wide array of products from various manufacturers. To support appropriate use for patient safety, regulatory bodies require manufacturers to strive for some degree of uniformity in product labeling. This article describes and interprets the symbols used on product labeling for catheters and addresses a number of frequently voiced related clinical concerns.