The safety of invasive monitoring in infants and children: Complications of central venous access

Abstract

SUMMARY

In critically ill pediatric patients, central venous access may serve many objectives including the administration of life-saving medications, a secure source of vascular access, and a site for monitoring central venous pressure and obtaining intermittent blood samples. As with any invasive procedure, the risk-benefit ratio must be considered. Although a CVC may be used to provide life-saving therapies, complications and adverse effects may occur. These complications may occur during catheter placement or with its subsequent use. The two factors that have provided the most dramatic impact in decreasing complications include the use of ultrasound for CVC placement and the placement checklist recommended by Dr. Pronovost. Ultrasound has been shown to increase the success rate and decrease the complication rate by helping the clinical avoid inadvertent carotid puncture and excessive depth of needle insertion which may result in pneumothorax. With ongoing use in the ICU setting, a daily reassessment of the need for central venous access should be included into the rounding checklist so that consideration regarding removal of the line is discussed on a daily basis.