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This step-by-step guide to the procedure of central venous line insertion in children is primarily aimed at those new to the procedure, however clinicians familiar with the procedure in adults will still find some key pearls on how to modify their standard technique to achieve a high success rate in small infants.
Videos of Central Line Insertion in Children
For those of us yet to acquire an echo machine, which one would be easier: jugular or subclavian? And are the landmarks the same as in the adult?
Hi Adnane, I only do ultrasound guided insertion, but the landmarks are the same as in adults. We also do a lot of femoral lines in children so it is also and option. In general due to the higher risk of pneumothorax with subclavian lines and the difficultly with applying pressure to any bleeding caused I generally stay away from subclavian lines. In general an internal jugular line is easier than a femoral line due to the vessel size, however there still a risk of pneumothorax particularly if done blindly. I mostly do a mixture of internal jugular and femoral depending on the patient.
I thoroughly enjoyed Dr Flannigan’s presentation. We have been using transfixion and cathlons instead of needles for some years in our youngest patients and indeed this technique works like a dream. We tend to pull the cathlon slowly back and rely on passive blood return instead of aspiration and we don’t push forward the cathlon after we locate the vein. Dr Flannigan elaborated on this modification of the technique nicely. On the other hand we always use straight soft tip wires for our patients below 5 kg and so far we haven’t seen haemotamponnade. We have had that complication once in the past when a colleague had used the stiff straight end of a regular J wire. Another serious complication we had was air embolus caused by deep inspiration during port-a-cath placement hence the need for good sedation +/- relaxation for the procedure.
Again, thanks Dr Flannigan for a lovely presentation. Indeed cathlons, ultrasound, straight wires and transfixion are the things you need for neonates and small infants.
All good points, thanks for taking the time to share. Thats a great point about not just turning the J wire round. Also if my cannula isn’t all the way in I use the soft straight wire (J wire in this situation is a bad idea), but if all the way in I will use the J wire. Regards Chris
Thank u very much for a wonderful description and presentation, the very best i have found. I find it very challenging. Its probably because of the only available adult linear probe and needle technique that i have to use.We do have cvp lines of arrow & bbraun but we don’t have cannula type cvp that u have demonstrated. I have tried with the cannula technique with std cannulla but the problem with that is indentation of skin with out puncturing the vessel & hematoma if I miss after transfixation. It would be very kind of u if I could know the brand that u have shown in the demonstration so that i can use cannula technique like that u have shown?
The best cannula is the one thaty comes with the Vygon CVL, but the other ones I use are BD Insyte, they are not as still but ok for most circumstances.
The best video about central line placement in pediatrics .I found it very very useful as it’s complete step by step description of the whole procedure right from beginning to end. I’m in rural small pediatric set up in India of my own but I find this video good enough to learn the procedure. Thank you so much once again.
Found it very hard to do neonatal CV line insertion under USS guidence. Visualisation is good but the cannula is not enter into the vein a very distressed situation. What can I do the improve.