SERVICES
Paediatric vascular access

OVERVIEW

Vascular access refers to the process of gaining entry into a child's bloodstream for the purpose of administering medication, nutrition, or fluids. It involves the insertion of a catheter or needle into a vein, usually in the arm, to allow for the delivery of these substances directly into the bloodstream.

Paediatric vascular access can be challenging because children's veins are smaller and more delicate than those of adults and because they may be more anxious or scared during the procedure. There are several different methods of paediatric vascular access, including peripheral intravenous catheters, central venous catheters, peripherally inserted central catheters, Hickman lines and Ports.

The choice of method will depend on the child's age, medical condition, and duration and frequency of treatment. Successful paediatric vascular access is essential for the safe and effective delivery of medical care to children.

When is vascular access indicated?

Vascular access may be indicated in a variety of medical situations, including:

Administration of medications: Vascular access may be necessary to deliver medications directly into the bloodstream, such as antibiotics, chemotherapy drugs, and pain medications.
Nutritional support: Children who are unable to take in sufficient nutrition through oral feeding may require vascular access to receive intravenous nutrition.
Fluid replacement: Children who are dehydrated or have lost significant amounts of fluids due to illness or surgery may require vascular access to receive fluids.
Blood transfusions: Children who require blood transfusions may need vascular access to receive the transfusion.
Diagnostic testing: Vascular access may be needed to draw blood samples for diagnostic testing, such as blood glucose monitoring, electrolyte levels, or blood culture.
Dialysis: Children with kidney failure may require vascular access for dialysis, which involves filtering waste products from the blood.

The specific indication for vascular access will depend on the child's medical needs and condition.

How is vascular access inserted?

The approach for placing vascular access can vary based on the child's age, medical state, and the objective of the procedure. Below are some of the commonly employed methods:

Peripheral Intravenous Catheter (PIV): This is the simplest and most common type of vascular access. It involves inserting a small plastic catheter into a peripheral vein in the arm or hand. PIV is typically used for short-term treatment, such as administering medication or fluids.
Central Venous Catheter (CVC): This is a longer catheter that is inserted into a central vein in the chest, neck or groin, and it is used for long-term treatment. There are several types of CVCs, including peripherally inserted central catheters (PICC), tunnelled catheters, and implanted ports.
Arterial Lines: Arterial lines are inserted into an artery instead of a vein. They are used to monitor blood pressure, oxygen saturation, and other vital signs.
Intraosseous (IO) Access: IO access involves inserting a needle through the bone and into the marrow cavity to deliver fluids, medications, or blood products. IO access is typically used in emergency situations when vascular access cannot be obtained through other methods.
Hickman catheters or Ports: These are inserted in the theatre and can be used for prolonged periods of time.

Typically, healthcare professionals like nurses or physicians perform the insertion of vascular access under local anaesthesia or sedation. The specific technique used will depend on the type of vascular access and the child's age and medical condition.

REQUEST A CONSULTATION

Dr Mangray, the founder of KZN Specialised Paediatric Surgical Service, and his associates, Dr Ngobese, Dr Govender and Dr Dube-Zvirikuzhe, have a well-established reputation for caring for children right until late adolescence.

FREQUENTLY ASKED QUESTIONS

FAQ

1 What are the potential complications of vascular access?

The potential complications of vascular access include infection, bleeding, blood clots, catheter malposition, and fluid or medication leakage into surrounding tissues.

2Can children with difficult vascular access receive treatment?

Yes, children with difficult vascular access can receive treatment through alternative methods, such as intraosseous (IO) access or transcutaneous infusion devices.

3 What is the most common type of vascular access used in children?

Peripheral Intravenous Catheter (PIV) is the most commonly used type of vascular access in children. It is simple to insert, and it can be used for short-term treatment.