Name of the Procedure:

Insertion of Non-Tunneled Centrally Inserted Central Venous Catheter (CVC) in Children Under 5 Years

Summary

In this procedure, a central venous catheter (CVC) is inserted into a large vein, often in the chest, neck, or groin, to allow for direct access to the central bloodstream. This catheter is non-tunneled, meaning it is placed directly into the vein without tunneling under the skin.

Purpose

This procedure is performed to allow for the administration of medications, nutrients, blood products, or for drawing blood samples. It is essential in pediatric patients who require long-term intravenous (IV) therapy, monitoring, or treatment for chronic conditions.

Indications

• Need for prolonged IV therapy
• Administration of chemo- or antibiotic therapy
• Total parenteral nutrition (TPN)
• Hemodynamic monitoring
• Frequent blood draws

Preparation

• Fasting may be required for several hours before the procedure.
• Medication adjustments might be necessary, especially for those on blood thinners.
• Pre-procedure assessments include blood tests, imaging studies, and a physical examination.
• Consent forms must be signed by parents or guardians.

Procedure Description

1. The child is positioned, and the insertion site is sterilized.
2. Local anesthesia is administered, and general anesthesia may be used if necessary.
3. The clinician inserts a needle into the selected vein, guided by ultrasound.
4. A guidewire is threaded through the needle into the vein, and the needle is removed.
5. A dilator may be used to widen the insertion site.
6. The catheter is then threaded over the guidewire, and the guidewire is removed.
7. The catheter is secured in place and checked for proper placement using imaging like X-ray.
8. The site is cleaned and covered with a sterile dressing.

Duration

The procedure typically takes 30 minutes to an hour.

Setting

This procedure is performed in a hospital setting, often in an operating room, interventional radiology suite, or an intensive care unit.

Personnel

• Pediatric surgeon or interventional radiologist
• Anesthesiologist
• Nursing staff
• Medical technicians

Risks and Complications

• Infection at the insertion site
• Bleeding or hematoma
• Pneumothorax (collapsed lung) if inserted near the chest
• Thrombosis (clot formation)
• Catheter misplacement or malfunction

Benefits

• Direct and reliable access to the central venous system
• Reduced need for multiple needle sticks
• Effective delivery of medications and nutrients
• Immediate access for blood samples and monitoring

Recovery

• The child will be monitored for a few hours post-procedure.
• Pain management with medications as needed.
• Care instructions for the catheter site, including keeping it clean and dry.
• Follow-up appointments for catheter maintenance and monitoring.

Alternatives

• Peripheral IV lines for short-term therapy
• Tunneled central venous catheters or implanted ports for longer-term access
• Non-invasive oral or intramuscular medication administration

Patient Experience

The child will be asleep or sedated during the procedure, so they should not feel pain. Some discomfort or soreness at the insertion site is normal post-procedure. Pain management and comfort measures will be provided as needed.