Central venous access devices are beneficial in pediatric therapy because:
A. They are difficult to see.
B. They cannot be dislodged.
C. Use of the arms is not restricted.
D. They don’t frighten children.
Correct Answer: C. Use of the arms is not restricted.
The child can move his extremities and function in a normal fashion. This lessens stress associated with position restriction and promotes normal activity. After the decision has been made to place a CVAD, a suitable approach is chosen. A clear understanding of the anatomy is needed for each of the different approaches. The four main approaches to central venous access include the internal jugular, subclavian, femoral, and PICC techniques.
Option A: Fear may not be eliminated. Central venous access devices (CVADs) are used to deliver larger volumes of irritating solutions, such as antibiotics, blood products, parenteral nutrition media, and sclerosing chemotherapeutic agents. If patients need prolonged intravenous (IV) access, a CVAD is preferred to a peripheral IV line. Central access is also indicated when peripheral access cannot be achieved; however, in an emergency situation (eg, trauma), when peripheral and central access cannot be expeditiously obtained, the intraosseous route is the next best choice for obtaining vascular access.
Option B: All lines can be dislodged. CVADs improve the quality of life and patients’ safety. However, these catheters may lead to severe complications, e.g., infection, thrombosis, and dislodgement. Dislodgement was defined as the displacement of the tip of the CVAD into a non-central portion of the venous system.
Option D: Even small catheters can be readily seen. Central venous catheters (CVCs) are inserted at femoral, subclavian, and internal jugular sites. These devices are preferred in children who have no peripheral access and in those who require long-term IV access. The subclavian route has been the preferred route for many years and affords the patient the greatest mobility. The internal jugular vein (IJV), either via cutdown or via percutaneous access, is also a popular site in children that is amenable to placement under ultrasonographic (US) guidance.