JOURNAL ARTICLE

Improved percutaneous insertion of long-term central venous catheters in children: the 'shrug' manoeuvre

A J Holland, W D Ford
Australian and New Zealand Journal of Surgery 1999, 69 (3): 231-3
10075367

BACKGROUND: Surgical central venous access in children usually requires open exposure of the internal jugular vein or one of its tributaries. The percutaneous route has the potential advantages of a reduced rate of wound infection, superior cosmesis and reduced operating time. We report our modifications to the percutaneous approach that facilitate the application of this technique to children over the age of 12 months.

METHODS: The dilator and peel-away sheath of the introducer set should be inserted into the subclavian vein under fluoroscopic control. Elevation of the ipsilateral shoulder assists passage of the peel-away sheath and subsequently the catheter from the subclavian vein into the superior vena cava.

RESULTS: This technique has been used successfully to establish surgical central venous access in the majority of children at the Women's and Children's Hospital, Adelaide, South Australia, over a 3-year period.

CONCLUSIONS: With the modifications described this technique may be safely applied to the paediatric age group.

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