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Vascular Access Treatment in Children

Vascular Access Treatment in Children in Bhubaneswar

In Pediatric General Surgery, Vascular Access plays a vital role in delivering essential treatments and monitoring. Children often require surgical interventions that necessitate reliable access to their circulatory system. Peripheral Intravenous Catheters (PIVCs), Central Venous Catheters (CVCs), and Peripherally Inserted Central Catheters (PICCs) are commonly used methods to establish Vascular Access. However, due to the unique anatomical considerations in children, accessing veins can be challenging. Specialised techniques and equipment are employed to ensure successful placement while minimising discomfort and complications. Proper management and monitoring are essential to mitigate risks such as infection and thrombosis associated with Vascular Access procedures, thereby promoting optimal outcomes for paediatric patients undergoing surgery.

Manipal Hospital is a Paediatric hospital in Bhubneswar that specializes in all child-related health issues. Visit our Paediatric doctor in Bangalore today for a consultation.

FAQ's

Vascular Access is done for a variety of reasons, some of which are:

  • The delivery of drugs that need to be dosed often or continuously infused.

  • Prolonged intravenous treatment for diseases such as renal failure, cystic fibrosis, or cancer.

  • Haemodynamic parameter monitoring in children who are extremely ill.

  • Blood collection for laboratory examinations in young patients with challenging peripheral vein access.

  • Parenteral nutrition is a means of providing nutrition to children who cannot tolerate enteral feeding.

  • Allowing blood transfusions and administering contrast materials for imaging examinations. 

Mainly, the types of Vascular Access are as follows: 

  • Peripheral Intravenous Catheters (PIVCs): These are temporary access devices inserted into peripheral veins.

  • Central Venous Catheters (CVCs): Placed for long-term access into larger central veins such as the jugular or subclavian.

  • Peripherally Inserted Central Catheters (PICCs): These are excellent for long-term therapy; they are inserted into peripheral veins and terminate at a central vein.

  • Arterial lines: Placed directly into arteries to take blood samples or monitor blood pressure continuously in critical care conditions. 

In infants and kids, the femoral vein, the subclavian and axillary veins, and the external and internal jugular veins are the preferred locations for central Venous Access. 
 

Arterial Catheterisation is contraindicated in cases like

  • Probability of abnormal perfusion distal to the cannulation site (perform the Allen test)

  • Skin infection at the entrance location

  • Formation of a thrombus

  • Ischaemia away from the point of insertion

  • Embolisation

  • Loss of distal structures, such as hands, feet, fingers, and toes

  • Infection (very rare)

  • Vascular-arterial fistulas

Establishing Vascular Access in children involves ensuring their comfort and safety throughout the procedure. Initially, the optimal location for access, typically the hands, arms, or scalp, is determined. If needed, ultrasound guidance aids in delicately inserting the catheter into the chosen vein under sterile conditions. Continuous monitoring of the child's comfort and vital signs occurs throughout the procedure. Once access is achieved, the catheter is secured, and instructions for home care are provided
 

Vascular Access establishment in children presents particular difficulties. Smaller vessel diameter, vascular hyperreactivity, and trouble seeing and feeling veins because of too much subcutaneous fat. 
 

It is possible to use the umbilical vein temporarily. Bedside catheterisation of newborns weighing as little as 500 g is now possible because of the development of the Peripherally Inserted Central Catheter (PICC). 
 

The best option for your access is likely a fistula, as these often stay longer and have fewer issues with clotting and infections. On the other hand, some people might not be able to have a fistula due to weak blood vessels. Grafts are regarded as the backup option for access.

The following are complications linked to vascular access in children:

  • Infection: At the insertion site, there is a chance of a local or systemic infection.

  • Thrombosis: Blood clots forming in the catheter or other blood vessels.

  • Occlusion: When the catheter becomes blocked, blood flow or the administration of medication is hampered.

  • Phlebitis: Vein inflammation resulting in discomfort, swelling, and redness.

  • Catheter dislodgement: Unintentional displacement or extraction of the catheter from the vein.

  • Haematoma: A blood clot forms outside the vessel as a result of trauma or incorrect implantation.

  • Air embolism: When air enters the bloodstream, it can cause major problems.

  • Nerve injury: When a catheter is inserted, adjacent nerves may be damaged, leading to pain or dysfunction. 

Guidelines for parents following the placement of Vascular Access:

  • Monitor for any symptoms of infection, such as redness, swelling, or discharge, at the site of insertion.

  • To avoid infection, keep the area dry and clean.

  • To keep the catheter from falling, refrain from pulling or exerting pressure on it.

  • When handling the catheter, use good hygiene procedures.

  • Immediately notify the healthcare provider of any changes or concerns.

  • Learn knowledge about how to maintain and cleanse the catheter following the guidelines provided.

  • Keep your regular follow-up appointments to receive maintenance and monitoring. 

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