INDICATIONS AND COMPLICATIONS OF CENTRAL VENOUS CATHETERIZATION IN CRITICALLY ILL CHILDREN IN INTENSIVE CARE UNIT

Abstract

Background: Nothing can be more difficult, time consuming and frustrating than obtaining vascular access in critically ill pediatric patient¹ .Central venous catheters are widely used in the care of critically ill patients.

Methodology: This paper reviews our experience with central lines in 28 critically ill patients including neonates and non-neonates, in a study period of October 2008 to October 2009. Of the total 28 patients, central venous catheterizations was more in those who were more than a month age and of female sex.

Results: The route of insertion was femoral in approximately 89% of our patients and insertion was successful in 24 patients. The most common indication we observed for catheter use was, venous access in shock (37.1%) in neonates and for monitoring the central venous pressure (32%) in non neonate patients of ARDS with pulmonary edema and Shock. The central line was removed in majority of patients (60%) within 24-48hrs of insertion and was kept for maximum of six days in just one patient. Organism most frequently isolated was Acinetobacter. Recommendations made include, use strict aseptic measures by restricted number of skilled operators while inserting and during maintaining central line, routine confirmatory x-ray or fluoroscopy to check the position of central line before catheter use, if possible, use for central pressure monitoring recommended.

Conclusion: We concluded that central venous catheterization is a safe and effective measure so we recommend timely and judicious  use of  percutaneous central venous catheter in paediatric critically ill patients of PICU and NICU.