Permanent central venous access devices.

The development of permanent central venous access devices in the last 20 years has been accompanied by decreased complication rates, improved patient comfort, and increased cost-effectiveness. Subclavian venous access, first applied to infants and small children in the early 1970s, has given way to the Silastic permanent right atrial catheter by both cutdown and percutaneous techniques. The disadvantages of an occlusive aseptic dressing, frequent catheter irrigation, and disturbance of body image led to development of the totally implantable venous access system, which has been successfully used for long-term infusion of chemotherapeutic agents, antibiotics, blood products, and total parenteral nutrition. The recent introduction of permanent peripheral central venous catheters has further decreased the expense and complication rate of long-term venous access in infants and children. These developments and the accumulated expertise in finding alternative venous access sites (common facial, deep inferior epigastric, lumbar, and azygos veins) have helped minimize mechanical and septic complications and have increased the safety of even the most difficult venous access procedures.