Vascular Access in Critically Ill Children.

Abstract

* Abbreviations: ED — : emergency department miniMAGIC — : Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics NTCVAD — : nontunneled central vascular access device PED — : pediatric emergency department PICC — : peripherally inserted central catheter PIVC — : peripheral intravenous catheter VAD — : vascular access device Vascular access devices (VADs) are commonly inserted, often in a time sensitive manner, in critically ill children to provide life-sustaining therapy, including but not limited to fluid resuscitation, antibiotics, vasopressors, or parenteral nutrition, and for hemodynamic monitoring. Among children admitted to the pediatric emergency department (PED), VAD selection is limited to peripheral intravenous catheter (PIVC), intraosseous device, and nontunneled central vascular access device (NTCVAD). VAD selection is more varied in the PICU and includes peripherally inserted central catheter (PICC), midline catheter, tunneled cuffed central VAD, and totally implanted venous device in addition to those that are available in the PED. Regardless of setting of care, currently there is no evidence-based guidance for VAD selection. In general, PIVCs are the mainstay for critically ill children in the PED, and PIVC and NTCVAD are the mainstays for those in the PICU. However, given the concerns of central line–associated bloodstream … Address correspondence to Sarah B. Kandil, MD, Department of Pediatrics, Yale School of Medicine, Yale University, 333 Cedar St, New Haven, CT 06520. E-mail: sarah.kandil{at}yale.edu