Ares Guillermo, Hunter Catherine J
Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Curr Opin Pediatr. 2017 Jun;29(3):340-346. doi: 10.1097/MOP.0000000000000485.
Central venous catheters (CVCs) have a prominent role in the diagnostic and therapy of neonates and children. Herein, we describe the multiple indications for CVC use and the different devices available for central venous access. Given the prevalent use of CVCs, healthcare systems are focused on reducing complications from their use, particularly central line-associated bloodstream infections (CLABSIs). The most up-to-date information available sheds light on best practices and future areas of investigation.
Large systematic reviews of randomized trials suggest that ultrasound guidance for placement of CVCs in children is safer than using blind technique, at least for internal jugular vein access. Appropriate catheter tip placement is associated with decreased complications. Furthermore, the prophylactic use of ethanol lock between cycles of parenteral nutrition administration has reduced the rates of CLABSI. A recent randomized trial in pediatric CVCs showed a benefit with antibiotic-coated CVCs.
Based on the available evidence, multiple techniques for CVC placement are still valid, including the landmark technique based on practitioner experience, but ultrasound guidance has been shown to decrease complications from line placement. Adherence to CVC care protocols is essential in reducing infectious complications.
中心静脉导管（CVC）在新生儿和儿童的诊断及治疗中发挥着重要作用。在此，我们描述了使用CVC的多种适应证以及可用于中心静脉通路的不同装置。鉴于CVC的广泛使用，医疗系统致力于减少其使用相关的并发症，尤其是中心静脉导管相关血流感染（CLABSI）。现有最新信息揭示了最佳实践方法和未来的研究领域。
对随机试验的大型系统评价表明，至少对于颈内静脉置管，在儿童中使用超声引导放置CVC比盲目技术更安全。合适的导管尖端位置与并发症减少相关。此外，在肠外营养给药周期之间预防性使用乙醇封管降低了CLABSI的发生率。最近一项针对儿科CVC的随机试验显示，使用抗生素涂层CVC有获益。
基于现有证据，多种CVC置管技术仍然有效，包括基于从业者经验的体表标志技术，但已证明超声引导可减少置管相关并发症。遵守CVC护理方案对于减少感染性并发症至关重要。
