Jeanne M. Rorke

Jayashree Ramasethu

A. Alfred Chahine

32 Central Venous Catheterization

Central venous catheters provide stable IV access to sick or

low-birthweight infants who need long-term IV nutrition or

medications (1).

A percutaneous central venous catheter, also known as

a peripherally inserted central catheter (PICC), is a soft,

flexible catheter that is inserted into a peripheral vein and

threaded into the central venous system. Central venous

lines may be placed by surgical cutdown when percutaneous access is not possible. Totally implantable vascular

access devices (ports) are rarely used in neonates and are

thus not included in this chapter.

Regardless of the method employed to obtain secure

and reliable venous access, the clinician should be familiar

with the technique and anatomic considerations unique to

the approach. Some form of analgesia and sedation is generally required, with general anesthesia being reserved for

more complex access cases. The majority of venous access

procedures in the critically ill neonate are performed at the

bedside rather than in the operating room.

A. Common Indications

1. Total parenteral nutrition

2. Long-term IV medication administration

3. Administration of hyperosmolar IV fluids or irritating

medications that cannot be administered through

peripheral IV cannulas.

4. Fluid resuscitation

5. Repetitive blood draws (catheters are not usually

inserted primarily for this indication in neonates; only

larger-lumen catheters may be used for blood draws

without risk of clotting).

B. Relative Contraindications

There are no absolute contraindications, as the clinical situation dictates the need for venous access.

1. Skin infection at insertion site

2. Uncorrected bleeding diathesis (not a contraindication

for percutaneous catheters inserted in distal peripheral

venous sites)

3. Ongoing bacteremia or fungal infection (which may

cause catheter colonization and infection)

4. The patient can be treated adequately with peripheral IV access. Central venous catheters have significant risks of complications and must not be used

when peripheral venous access is possible and

adequate.

C. General Precautions

1. Central venous catheterization must be performed by

trained individuals who are familiar with the venous

anatomy of the proposed catheter route.

2. Obtain informed consent prior to performing the procedure.

3. Plan ahead: Success with PICC placement is higher if

the catheter is inserted electively before peripheral

veins are “used up” by frequent cannulations.

4. Infant should be on a cardiorespiratory monitor during

the procedure.

5. Follow the manufacturer’s instructions for catheter

use.