Vascular Access in Children With Congenital Heart Defects.

Abstract

* Abbreviations: CVAD — : central venous access device miniMAGIC — : Michigan Appropriateness Guide for Intravenous Catheters in pediatrics VAD — : vascular access device Vascular access in pediatric cardiac patients is an inherently complex topic. Many clinicians struggle to understand the “plumbing,” let alone the implications that particular cardiovascular anatomic and physiologic derangements and our strategies of palliation have for children, both for the present and the future. Each choice a clinician makes regarding where and how to place a vascular access device (VAD), the length and diameter of the catheter, the surveillance and maintenance practices for the catheter, the duration the catheter is left indwelling, the types of therapies administered through the catheter, the blood sampled through the catheter, and the decision to remove the catheter can have major implications for a child’s future candidacy for additional catheterization and surgery. Simultaneously accounting for all of these factors can result in an incomprehensible morass. Through the Michigan Appropriateness Guide for Intravenous Catheters in pediatrics (miniMAGIC), we have employed the use of an expert panel and the RAND Corporation and University of California, Los Angeles appropriateness methodology (which is similar to the approach that was used … Address correspondence to Ranjit Aiyagari, MD, Division of Pediatric Cardiology, C.S. Mott Children’s Hospital, 1540 E Hospital Dr, Ann Arbor, MI 48109-4204. E-mail: ranjita{at}umich.edu