CENTRAL VENOUS CATHETER ACCESS

Central venous access for the purpose of supplying parenteral nutritio n to the pediatric age group requires a careful definition of the pati ent's caloric need, estimated duration of therapy, and an assessment o f available sites. Peripheral vein parenteral nutrition is limited by caloric density of the nutrient fluids, while peripherally inserted ce ntral catheters (PICC) offers a new technology for accessing central v eins while obviating the risk of central vein access. Routes of centra l vein access are several and there are also a variety of catheters av ailable for placement. Tunneled percutaneous placement of silicone rub ber cuffed catheters via the subclavian vein approach is that techniqu e we use most commonly. The risks of such access catheters include mec hanical risks of placement, venous thrombosis of the access sites, and most importantly catheter related infections, either at the exit site , the subcutaneous tunnel or pouch, or even generalized sepsis. With a full knowledge of the spectrum of access techiques, access materials, and risks, safe total parenteral nutrition can be safely delivered to the children in need. (C) Elsevier Science Inc. 1998.