Catheter Management in Pediatric Patients

Catheter Selection and Indications

The American Society for Parenteral and Enteral Nutrition recommends tunneled cuffed Hickman catheters (or Broviac catheters) for pediatric patients requiring prolonged parenteral nutrition or long-term venous access 1, 2
Tunneled Hickman/Broviac catheters should be used for long-term PN and home PN in children, as recommended by the American Society for Parenteral and Enteral Nutrition 1, 2
For hospitalized children requiring prolonged PN, either PICC or tunneled CVC are appropriate, according to the American Academy of Pediatrics 1
Use single-lumen catheters whenever possible to minimize infection risk, as suggested by the Centers for Disease Control and Prevention 1, 2
If multi-lumen catheters are necessary, dedicate one lumen exclusively to PN, as recommended by the American Society for Parenteral and Enteral Nutrition 1, 2

Verify no infection at proposed insertion site (absolute contraindication), as recommended by the Society of Pediatric Anesthesia 3
Assess for distorted anatomy or known venous thrombosis at insertion site, according to the American Academy of Pediatrics 3
Check coagulation parameters: proceed if platelet count >50 × 10⁹/L, aPTT <1.3 times normal, INR <1.8, as suggested by the American Society of Anesthesiologists 4, 5

Femoral vein is acceptable in children when superior vena cava access is not possible, as recommended by the American Academy of Pediatrics 1
Avoid subclavian site in patients with advanced kidney disease or severe respiratory compromise, according to the National Kidney Foundation 3
Position catheter tip between lower third of superior vena cava and upper third of right atrium, as recommended by the American College of Cardiology 8
Confirm tip position with X-ray imaging (standard for pediatric patients), as suggested by the American Academy of Pediatrics 4, 5

Dedicate the catheter exclusively to PN administration when possible, as recommended by the American Society for Parenteral and Enteral Nutrition 1, 2
Avoid blood sampling, transfusions, and central venous pressure monitoring through the PN lumen, according to the Centers for Disease Control and Prevention 1, 2
Use sterile gauze with tape or transparent semi-permeable polyurethane dressing, as suggested by the American Academy of Pediatrics 10
Replace gauze dressings every 2 days; transparent dressings every 7 days, as recommended by the Centers for Disease Control and Prevention 10

Do not administer prophylactic systemic or intranasal antimicrobials, as recommended by the Centers for Disease Control and Prevention 6
Do not use antimicrobial-coated CVCs for long-term PN in children, according to the American Academy of Pediatrics 1
Admix all parenteral fluids in pharmacy using laminar-flow hood and aseptic technique, as suggested by the American Society for Parenteral and Enteral Nutrition 6

Implement multimodal protocols ("bundles") standardizing insertion and maintenance practices, as recommended by the Joint Commission 11
Provide regular training and education for healthcare staff, according to the American Academy of Pediatrics 10, 11
Conduct regular audits of catheter-related practices, as suggested by the Centers for Disease Control and Prevention 10, 11
Monitor catheter-related bloodstream infection rates per 1000 catheter-days, as recommended by the National Healthcare Safety Network 6