Overview
Pediatric Central Line insertion is a procedure used to establish long-term vascular access in children. This includes PICC lines, tunneled catheters, and non-tunneled central venous catheters for various indications.
Central lines are essential for long-term medication administration, total parenteral nutrition, frequent blood sampling, and hemodynamic monitoring in critically ill children. Proper technique is crucial to avoid complications.
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Indications
Extended antibiotic therapy for infections
Nutritional support when oral/enteral feeding inadequate
Administration of chemotherapeutic agents
Regular laboratory monitoring
Central venous pressure monitoring
Contraindications
Absolute Contraindications
Relative Contraindications
📋 Equipment Checklist
Check off items as you gather them:
Pre-procedure Preparation
Preparation includes explaining the procedure to patient and family, selecting appropriate catheter type and size, gathering necessary equipment, ensuring proper patient positioning, and preparing the insertion site. All team members should understand their roles.Step-by-Step Procedure
Step 1: Patient Preparation
Explain procedure to patient and family. Position patient appropriately. Administer sedation if needed. Prepare sterile field.
⚠️ Common Mistakes to Avoid:
- Inadequate explanation
- Poor positioning
- Insufficient sedation
💡 Pro Tip:
Use age-appropriate language and involve parents in the process.
Step 2: Site Selection
Select appropriate vein (subclavian, internal jugular, femoral). Use ultrasound to assess vein patency and size. Mark insertion site.
⚠️ Common Mistakes to Avoid:
- Poor site selection
- Not using ultrasound
- Ignoring contraindications
💡 Pro Tip:
Ultrasound guidance improves success rate and reduces complications.
Step 3: Vein Puncture
Use ultrasound guidance to puncture vein. Confirm blood return. Insert guidewire. Confirm wire position.
⚠️ Common Mistakes to Avoid:
- Poor ultrasound technique
- Inadequate blood return
- Wrong wire position
💡 Pro Tip:
Always confirm guidewire position before proceeding.
Step 4: Tract Dilation
Make skin incision. Dilate tract with dilator. Remove dilator while maintaining wire position.
⚠️ Common Mistakes to Avoid:
- Inadequate dilation
- Losing wire position
- Poor technique
💡 Pro Tip:
Maintain wire position throughout the procedure.
Step 5: Catheter Insertion
Thread catheter over guidewire. Advance to appropriate depth. Remove guidewire. Confirm placement.
⚠️ Common Mistakes to Avoid:
- Wrong catheter depth
- Poor threading technique
- Inadequate confirmation
💡 Pro Tip:
Use chest X-ray to confirm catheter tip position.
Step 6: Securing and Dressing
Suture catheter in place. Apply sterile dressing. Document procedure details. Order chest X-ray.
⚠️ Common Mistakes to Avoid:
- Poor securing technique
- Inadequate dressing
- Poor documentation
💡 Pro Tip:
Secure the catheter properly to prevent dislodgement.
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Post-procedure Care
Post-insertion care involves confirming proper placement with imaging, securing the catheter, monitoring for complications, and documenting the procedure. Regular assessment and maintenance are essential.Complications & Management
| Complication | Incidence | Signs | Management | Prevention |
|---|---|---|---|---|
| Infection | 5-15% | Redness, warmth, pain at site, fever | Antibiotics, catheter removal if needed | Strict aseptic technique, proper care |
| Thrombosis | 10-20% | Swelling, pain, decreased flow | Anticoagulation, catheter removal | Proper technique, heparin flush |
| Pneumothorax | 1-5% | Chest pain, shortness of breath | Chest X-ray, chest tube if needed | Ultrasound guidance, proper technique |
| Malposition | 5-10% | Poor flow, arrhythmias | Reposition or replace catheter | Proper technique, confirmation |
Clinical Pearls
Use age-appropriate language and involve parents in the process.
Ultrasound guidance improves success rate and reduces complications.
Always confirm guidewire position before proceeding.
Maintain wire position throughout the procedure.
Use chest X-ray to confirm catheter tip position.
Secure the catheter properly to prevent dislodgement.
Strict aseptic technique is crucial for preventing infections.