Selecting Components for Pediatric Vascular Access Catheters

 

Vascular access in children is often challenging. Veins in children are small and sometimes mobile, and they can be difficult to visualize because of subcutaneous fat. Children can also be less cooperative than adults. As a result, the quality, features, and reliability of vascular access catheters and other devices are crucial to procedural success.

Choosing the best components (needles, guidewires, introducers, etc) for your pediatric vascular access devices will ensure you have the best product features, levels of quality, and standards of reliability. This, in turn, will help position your products ahead of the competition, building and maintaining a loyal customer base.

Vascular Access in Children

Pediatric vascular access can be broadly categorized as:

• Short-term vascular access, often for the administration of fluids and medications.
• Long-term vascular access for the repeated administration of medication, total parental nutrition, chemotherapy, etc.

Vascular access can also be required in children for repeated blood sampling.

The main objective of a vascular access device is to gain access, but there are other objectives that are also important. They include:

• Minimizing the number of access attempts and maximizing first-attempt success rates.
• Minimising trauma to the patient.
• Minimizing time to guidewire insertion and time to cannulation.
• Ensuring correct guidewire placement.

These objectives are important for all patients, but there is an enhanced focus with children.

Clinician Considerations

Clinicians consider a range of factors when deciding on a vascular access approach and the medical devices that will be used to complete the procedure:

• Patient’s condition
• Patient’s size
• Patient’s age
• Availability of venous access sites
• Nature of treatment
• Properties of the infusate
• Length of time access is needed
• Preferences of the parents

The Main Pediatric Vascular Access Options

Peripheral access is often used for short-term catheters, blood sampling, and maintenance of IV fluids. The risks of peripheral access include the potential for occlusion. This is not a suitable option for some types of medications.

Central venous access, on the other hand, is generally the preferred approach for procedures such as total parenteral nutrition, chemotherapy, situations where repeated or long-term access is required, in critical care monitoring and medication situations, and for emergency access such as cardiopulmonary arrest. The risk of infection is one of the main risks.

PICC Lines

PICC (peripherally inserted central catheters) lines are common in neonatal intensive care units and for vascular access in infants. This vascular access option is suitable for a range of indications as well as for inpatient and outpatient therapy.

PICC lines reduce overall risks compared with surgical vascular access. They also reduce specific risks, such as the risk of the device becoming dislodged, or the risk of cardiac arrhythmias, air embolization, and pneumothorax. PICC lines are also easy to remove.

Central Venous Catheter

The subclavian vein is typically the access location with central venous catheters, although the superior arch of this vein in children under 12 months needs to be taken into account.

Umbilical Vascular Access

Umbilical vascular access is an option in the first few days after birth. It is suitable for blood sampling, monitoring central venous pressure, and the administration of medications. Complications such as infection, thrombosis, dislodgement, occlusion, malposition, and migration are common with umbilical access in neonates.

Minimizing Complications

Through their design, features, and quality, pediatric vascular access devices should help clinicians reduce the risk of complications. This includes acute complications such as pneumothorax, air embolism, vascular damage, and tissue trauma.

Insertion using ultrasound guidance by trained clinicians has been found in studies to reduce the risk of acute complications. Ultrasound guidance has also been shown to minimize the number of access attempts as well as reducing procedure times.

Ultrasound guidance helps clinicians ensure accurate puncture site location and approach angle, as well as guidewire placement. The ongoing monitoring through fluoroscopy (and evacuation when necessary) is also essential to reduce the impact of potential acute complications. Acute complications can also be minimized by ensuring the patient is correctly positioned and, where necessary, restrained.

Potential long-term complications that can result from vascular access procedures include infection, thrombotic complications, catheter migration, and catheter occlusion.

Choosing the Best Components for Your Products

Device size is an essential consideration for clinicians in vascular access procedures. The factors that are considered include the access vein, the number of lumens required in the catheter, and the nature of the therapy. Clinicians generally aim to use the smallest possible catheter with the fewest number of lumens. For example, 18–24-gauge needles and 3-4 French (Fr) catheters.

Catheter-to-vein ratio is an important consideration in reducing the risk of complications. The general recommendation is a catheter-to-vein ratio of less than 50 percent for pediatric patients and less than 33 percent for neonates.

At Galt, we supply a range of vascular access devices, components, and accessories suitable for pediatric procedures. This includes needles in various configurations and sizes, including 24-gauge needles, as well as guidewires with outer diameters as small as 0.018”. Our range also includes hemostasis valve introducers with sheath diameters as small as 4Fr, micro access tearaway dilators with sheath diameters as small as 2Fr, and more. For more information and advice on choosing the best components and devices for your pediatric vascular access products and requirements, please get in touch with us at Galt today.