Serviço de Cirurgia Pediátrica, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisboa
- Palestra - I International Congress on Vascular Access (CIAV), September 26–27, 2019, Coimbra, Portugal
Resumo: Vascular access is an essential step in the management of nearly every hospitalized child. Obtaining a vascular access in pediatrics may be a challenge for medical as well as nursing staff. Each vessel presents its own unique set of risks and complications. The safest and most effective vascular access is obtained by carefully matching the child's size, urgency of need, therapeutic needs, and length of required treatment with the most appropriate device and technique. The technical complexity and difficulties are higher in the pediatric context. A peripheral intravenous (PIV) cannula is the most used device. Several techniques have been shown to be beneficial such as warming the extremity, transillumination, and epidermal vasodilators, ultrasound guidance, sedation and general anesthesia. In the neonates we have umbilical vein and artery access. The peripherally introduced central catheter (PICC) provide reliable central venous access in neonates and older children without the need for directly accessing the central veins. With unsuccessful PICC line placement or when a more durable long-term line is required, a tunneled central venous catheter or a totally implantable intravascular device (port) are the best options. The current Pediatric Advanced Life Support (PALS) recommendation is to establish Intraosseous access promptly if PIV access cannot be attained rapidly in an emergency. The use of real-time ultrasound has become the standard of care for percutaneous central venous access in pediatric patients and has been shown to decrease overall number of attempts, complication rates and save time. Maintaining long-term venous access in children with chronic needs such as short-gut syndrome can be quite challenging. Children who have had multiple previous CVCs can have thrombosis or stenosis of the central veins that precludes successful placement of a new catheter. Doppler US or magnetic resonance angiography can be used to survey the central veins, including the brachiocephalic vein, the superior and inferior vena cava.
Palavras Chave: Central venous catheters, peripheral intravenous cannula, ultrasound, vascular access