Central Venous Catheter Access Sizes,Indications,Seldinger Technique

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VASCULAR ACCESS IN PEDIATRICS

Central Venous Catheter Sizes In Pediatrics

Related topics

Peripheral Vascular Access

Indications For Arterial Catheterization

Intraosseous Infusion

Central Venous Access

Umbilical Vein and Arterial Catheterization and Venous Cutdown Sites

Dr Sunita Goel
Lecturer in Anaesthesiology
BJ Wadia Childrens hospital

Central venous catheter sizes in
pediatrics:

Weight (kg)	Age (years)	Size (French)
<5	0 - 0.5	3,4
>5	0.5 - 1.5	5,7
>15	5 - adult	5 - 11

Indications for central venous access

Central venous pressure (CVP) measurement
Delivery of drugs
Administration of high concentration parenteral alimentation
Rapid infusion of large volumes of fluids or blood products
Exchange transfusion
Chemotherapy
Blood sampling
Administration of vasoconstrictors inotropes
Hemodialysis or hemofiltration
Plasmapheresis

Sites for central venous catheters

Internal jugular
External jugular
Antecubital
Subclavian
Femoral

The Seldinger technique

Localize the desired vessel
Introduce a thin wall needle
Introduce a guidewire through the needle into the vessel
Make a skin incision and dilate
Insert the catheter over the wire

Contra-indications for central venous access (relative)

Infected skin site
Hypercoagulable states (thrombosis)
Increased intracranial pressure (for bilateral jugular veins)
Bacteremia (colonization of catheter)
Bleeding diathesis

Positioning of the central catheter tip

Obtain a chest x-ray
The tip should not intrude against a venous wall or the right atrium

Ideal position of central venous catheter tip

Just above the superior vena cava-right atrium junction
Just below the junction of the right atrium and inferior vena cava
Below the origin of renal veins (low femoral)

Complications of central venous access

Bleeding
Pneumothorax
Catheter thrombosis
Infection
Perforation
Arrhythmias
Embolism (air, catheter)
Endocarditis
Cardiac tamponade
Svc syndrome
Catheter fracture, malposition, migration

Next : Umbilical Vein and Arterial Catheterization and Venous Cutdown Sites

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