Advertising Disclaimer »

PEDIATRICS COVID-19 COLLECTION
Find the latest research and articles related to COVID-19 for free. View the collection | Find AAP resources here.

Racism and Its Effects on Pediatric Health
The American Academy of Pediatrics recognizes the harm racism causes to infants, children, adolescents, and their families. View the collection.
SUPPLEMENT ARTICLE

Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review

Rebecca S. Paterson, Vineet Chopra, Erin Brown, Tricia M. Kleidon, Marie Cooke, Claire M. Rickard, Steven J. Bernstein and Amanda J. Ullman
Pediatrics June 2020, 145 (Supplement 3) S243-S268; DOI: https://doi.org/10.1542/peds.2019-3474H
Download PDF

Abstract

OBJECTIVE: To critically review the evidence for the selection and insertion of pediatric vascular access devices (VADs).

DATA SOURCES: Data were sourced from the US National Library of Medicine, Cumulative Index to Nursing and Allied Health, the Cochrane Library databases, Embase, and international clinical trial databases.

STUDY SELECTION: Clinical practice guidelines, systematic reviews, cohort designs, randomized control trials (RCTs), quasi RCTs, before-after trials, or case-control studies that reported on complications and/or risk as well as reliability of VADs in patients aged 0 to 18 years were included.

DATA EXTRACTION: Articles were independently reviewed to extract and summarize details on the number of patients and catheters, population, age of participants, VAD type, study method, indication, comparators, and the frequency of VAD failure or complications.

RESULTS: VAD selection and insertion decision-making in general hospitalized and some specialized patient populations were well evidenced. The use of single-lumen devices and ultrasound-guided techniques was also broadly supported. There was a lack of RCTs, and for neonates, cardiac patients, patients with difficult venous access, midline catheters, catheter-to-vein ratio, and near-infrared devices, the lack of evidence necessitated broadening the review scope.

LIMITATIONS: Limitations include the lack of formal assessment of the quality of evidence and the lack of RCTs and systematic reviews. Consequently, clinical decision-making in certain pediatric populations is not guided by strong, evidence-based recommendations.

CONCLUSIONS: This is the first synthesis of available evidence for the selection and insertion of VADs in pediatric patients and is important for determining the appropriateness of VADs in pediatric patients.

  • Abbreviations:
    CPG —
    clinical practice guideline
    CVAD —
    central venous access device
    DVT —
    deep vein thrombosis
    ECG —
    electrocardiogram
    ED —
    emergency department
    IV —
    intravenous
    MeSH —
    Medical Subject Headings
    NIR —
    near-infrared
    PICC —
    peripherally inserted central catheter
    PIVC —
    peripheral intravenous catheter
    PN —
    parenteral nutrition
    RAND-UCLA —
    RAND Corporation–University of California, Los Angeles
    RCT —
    randomized control trial
    USG —
    ultrasound-guided
    VAD —
    vascular access device

    • What’s Known on This Subject:

    Individual studies, systematic reviews, and focused clinical practice guidelines that evaluate vascular access devices (VADs) in various pediatric populations are available. However, to date, no systematic review examining the appropriateness, and inappropriateness, of VADs across common pediatric clinical scenarios exists.

    What This Study Adds:

    There is strong evidence to support and facilitate appropriate clinical decision-making in some pediatric indications. However, certain populations, device types and characteristics, and insertion procedures are poorly evidenced, necessitating the application of clinical judgment for VAD decision-making.

    Vascular access devices (VADs) are a common and essential component of pediatric health care.1 A range of peripheral and central venous devices that provide a route to administer critical and supportive therapies such as antibiotics, nutrition, and chemotherapy exists. Poor choice of VAD can lead to the insertion of an inappropriate device, which reduces treatment efficiency and places the patient at increased risk of harm.2–5 Clinicians need to make device and insertion decisions that ensure optimum therapy provision while preventing or reducing VAD-related complications (such as infection, thrombosis, and vessel damage), patient distress, and treatment delays.6

    To make VAD choices that mitigate patient harm and optimize treatment provision, clinical decision-making needs to reflect current, evidence-based guidance for pediatric patients. Individual studies, systematic reviews, and focused clinical practice guidelines (CPGs), which evaluate VADs in various pediatric populations, are available. However, to date, no systematic review examining the appropriateness and inappropriateness of VADs across common pediatric clinical scenarios exists. Systematic identification of high-quality evidence is necessary, not just to inform clinical decision-making and improve patient outcomes, but to further identify gaps in evidence that translate to gaps in practice and increase the risk of patient harm. In this review, we aimed to systematically and pragmatically evaluate all available evidence and guidance for VADs to inform the determination of Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics7,8 using the RAND Corporation–University of California, Los Angeles (RAND-UCLA) Appropriateness Method.9

    Methods

    A systematic review was undertaken to synthesize existing evidence on selection and insertion of pediatric VADs following the RAND-UCLA Appropriateness Method.9 The systematic review protocol was registered and published with the International Prospective Register of Systematic Reviews (PROSPERO; CRD201994286)10 and is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards.11

    Search Strategy

    We conducted searches of the US National Library of Medicine (Medline), Cumulative Index to Nursing and Allied Health, Cochrane Library databases, Embase, and international clinical trial databases for all studies in which authors reported VAD use (success and complications) in a pediatric population from 2008 to May 16, 2018. Search terms were developed in collaboration with an experienced medical librarian. We used exploded Medical Subject Headings (MeSH) terms (eg, catheters) and relevant keywords and their variants (eg, child, pediatrics). Table 1 reveals the electronic database search strategy.

    View this table:
    TABLE 1

    Summary of Search Terms Used for the Electronic Database Search

    Eligibility Criteria

    Following the RAND-UCLA Appropriateness Method, our goal was to provide a critical review of the literature summarizing the scientific evidence available surrounding the appropriateness of pediatric VAD selection, insertion, and characteristics.9 This meant a range of study designs was eligible for inclusion, including existing CPGs, systematic reviews, randomized control trials (RCTs), quasi RCTs, before-after trials, cohorts, or case-control studies. Additionally, the guidelines and studies must have been published in a peer-reviewed journal and authors must have reported on complications and/or risk and reliability of VADs in patients aged term to 18 years in a pediatric hospital. We defined VADs to include intraosseous devices; midline catheters; peripherally inserted central catheters (PICCs); short and long peripheral intravenous catheters (PIVCs); tunneled, tunneled-cuffed, and nontunneled central venous access devices (CVADs); totally implantable venous devices; and umbilical catheters. We excluded studies that were not published in English and conference abstracts, animal studies, NICU studies, n = 1 studies, case reports, case-series reports, and qualitative reports. Although eligibility criteria were focused on pediatric studies (ie, term to 18 years), we determined that including preterm neonate and adult studies was preferential to no evidence.

    Outcome Measures

    The primary outcomes were defined a priori as (1) device and insertion characteristics that impact the success of VAD insertion and (2) device and insertion characteristics associated with VAD failure, due to complications before the completion of therapy, or successful VAD insertion. Device characteristics included VAD type, device catheter-to-vein ratio, and device lumens. Insertion characteristics included insertion site and location and the use of vessel visualization technology. Complications included but were not limited to central line–associated bloodstream infection (CLABSI), VAD-associated thrombosis, occlusion, catheter dislodgement, catheter-tip migration, catheter breakage or rupture, local infection, and phlebitis.

    Screening

    Title and abstract screening was performed independently by 2 review authors (E.B. and A.J.U.), excluding studies that did not meet eligibility criteria when this could be determined by the abstract alone. Full-text articles included for screening were reviewed by 2 review authors (E.B. and A.J.U.) and independently assessed against the inclusion or exclusion criteria. Duplicate publications were excluded. When individual studies that had been evaluated in a systematic review also returned in the search, the primary study was excluded to avoid repetition, and the systematic review was referred to. Any discrepancies between review authors were resolved through mutual discussion and, when required, a third, independent review author (M.C.) was consulted.

    Data Extraction and Synthesis

    All full-text articles that met inclusion criteria were independently reviewed by 3 review authors (R.S.P., E.B., and A.J.U.) to extract details on the number of patients and catheters, population, age of participants, VAD type, study method, indication, comparators, and the frequency of VAD failure or complications. These details were summarized in a data extraction sheet and were cross-checked for accuracy and agreement. Additional relevant references were identified by examining reference lists of included studies and guidelines. Hand-searched references were evaluated to ensure that they met inclusion criteria. After screening, pragmatic inclusion of wider studies was employed. That is, if no studies identified meeting the preferential inclusion or exclusion criteria, we included wider studies (eg, a priori area of deficit included neonates outside of the NICU). The extracted data were then combined by using narrative (descriptive) synthesis by categories (ie, outcome, vascular device, indication).

    Study Quality and Risk of Bias

    The methodologic quality, transparency, and relevance of all individual included studies were independently assessed by 2 review authors (E.B. and A.J.U.) by using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline12 and Critical Appraisal Skills Program (CASP) Cohort Study checklist.13 RCTs and systematic reviews were preferentially included as the gold standard level of evidence for evaluating VADs. However, when this level of evidence did not exist, a pragmatic approach was taken so that studies outside of the scope of the review (eg, laboratory, premature neonate, or adult studies) and CPGs (which may be limited by the number or quality of included studies) were incorporated into the review. To provide a synthesis of the available literature for the purpose of the RAND-UCLA Appropriateness Method,9 studies were categorized according to their methodology: (1) CPG, (2) systematic review or other review, (3) RCT, (4) observational study with comparator, and (5) other (clinical review, pilot study, laboratory study).

    Results

    Study Selection

    The results of the search strategy and study selection are summarized in Fig 1. Electronic database searches identified 7430 articles, and hand searches of the bibliography of included studies and clinical guidelines identified 30 additional articles for potential inclusion. After removal of duplicates and screening for eligibility, a total of 133 studies and CPGs met eligibility criteria and were included in data extraction.

    FIGURE 1
    FIGURE 1

    PRISMA flowchart of study selection. VA, vascular access.

    Study Characteristics

    The review includes 27 CPGs (20.4%), 11 systematic reviews (8.3%), 10 RCTs (7.6%), 79 observational studies (59.8%), 3 pilot studies (2.3%), 2 clinical reviews (1.5%), and 1 laboratory study (0.8%). These were sourced from research teams based in Africa (1.6%), Asia (9.3%), Europe (31.0%), the Middle East 2.3%), North America (40.3%), Oceania (11.6%), and South America (3.9%), with the majority sourced from the United States (n = 34; 37.8%). Subjects within the included studies ranged in age, from premature neonates up to 66 years, and required treatment of oncologic or hematologic conditions, support during critical care admission, or vascular access for hemodialysis, postsurgical, or general infusion therapy or parenteral nutrition (PN). Due to the heterogeneity across age and conditions in pediatric patients, included articles were divided into specific clinical subspecialties (eg, hospitalized pediatric patients, hematology or oncology; see Fig 2). Results from individual studies based on specific hospitalized populations are presented in Table 2 and include key characteristics for each study.

    FIGURE 2
    FIGURE 2

    Quantity of evidence based on patient subgroup. CVAD includes nontunneled, tunneled, and tunneled-cuffed CVADs.

    View this table:
    TABLE 2

    Summary of CPGs and Studies Included in Systematic Review

    VAD Selection in Hospitalized Pediatric Populations

    A total of 3 CPGs and 26 studies were included for general hospitalized pediatric patients, including 1 systematic review, 1 RCT, and 23 observational studies. These studies compared all VADs in hospitalized adult (n = 3); child (n = 13), infant (n = 2), and neonatal (n = 3); and surgical (n = 1) populations. With the exception of 1 CPG, no studies reported on midlines in the pediatric population, so adult studies were also included.14,43,94

    Neonates

    Overall, umbilical catheters were associated with high rates of complications, including catheter-related bloodstream infection, occlusion, dislodgement, thrombosis, and local infection or phlebitis, with device failure being common.6,15,30,54,57,125,127 Umbilical catheter malposition and catheter-tip migration during treatment also frequently occurred,6,142 with concerns that malpositioned or dislodged umbilical catheters may lead to severe hemorrhage and even death if not detected or rectified in a timely manner.58 Despite this, the literature reviewed indicated that umbilical catheter placement is common practice in neonates up to the first 7 days of life.23 Evidence for umbilical catheter dwell time was scarce and supported placement for short durations only, due to of increased risk of device failure.24,57 Consequently, guidance from available CPGs was limited but recommended placement only for as long as clinically necessary, or ≤14 days, if managed aseptically.136 Beyond 15 days, ambiguity in the literature regarding the patency of the umbilical vascular system and catheter for longer durations was evident.136,142 One CPG did support replacing any umbilical catheter with a PICC for central access >7 days to reduce risk of infection.136 Alternative VADs for neonates include PICCs and CVADs6,34,66,136; however, it was recognized that neonates frequently had poor or difficult-to-access venous assets,45,55 were more likely to have higher risk of insertion-related complications,55 and were at high risk of blockage across all devices.6

    Infants

    PICCs are commonly the first VAD choice for infants.136 Numerous studies found that PICCs in infants were associated with a lower risk of complications, particularly thrombosis,28,122 leading current CPGs to recommend their use in children <1 year and for therapies for longer durations (>7 days).56,122,136 Conversely, PIVCs had significantly higher rates of dysfunction in infants (50%) compared with children >1 year and for longer dwell times,125 with one CPG only recommending PIVCs for therapies <6 days.136 None of the included evidence evaluated the complications associated with midline catheters in infants; however, the National Association of Neonatal Nurses recommended them as an appropriate alternative for peripherally compatible intravenous (IV) therapy for <6 to 10 days in infants.136

    Compared to PICCs, tunneled-cuffed CVADs were associated with higher rates of thrombosis (although thrombosis tended to occur after longer durations in situ), with 60% of tunneled-cuffed CVADs developing deep vein thrombosis (DVT).67 Tunneled-cuffed CVADs were also associated with higher rates of insertion failure in infants and young children.55 Risk of infection in CVADs placed in infants was high, especially compared with toddlers, and was linked to the use of totally implantable venous devices.59 As tunneled CVADs and totally implantable venous devices restrict the future use and availability of accessed veins and insertion was related to a higher risk of complication, studies and CPGs indicated that their use in infants should be limited.97,136

    Children and Adolescents

    For hospitalized children and adolescents, PIVCs and midline catheters were reported as appropriate for short-term peripherally compatible therapies in multiple studies because of their low risk of catheter-related infections and thrombosis in comparison to PICCs.14,43,94,100,127,143 However, in one study, the authors suggested that these devices are associated with increased risk of occlusion with extended dwell times.127 PICCs were reported to have high insertion success rates84 and low failure rates in children and adolescents,6,59 although one study reported severe complications in 40.1% of failed PICCs, associated with increasing patient age.28 PICC insertion was commonly associated with short-term complications such as occlusion, CLABSI, and thrombosis,6,30 with rates of these events increasing with longer durations of therapy.30

    In comparison, tunneled-cuffed CVADs had high rates of infection (4.8%–19.9%)6 and were associated with short-term complications, such as infection, malfunction, leak, and malposition,59,134 and high rates of occlusion (12.1%).6 Although totally implantable venous devices had low rates of infection (0.01–0.28 per 1000 catheter days),6 they were associated with early complications, such as bleeding, pneumothorax, nerve lesions, catheter misplacement, occlusion, and skin damage,97,103 and long-term complications, such as infection, thrombosis, catheter fracture or disconnection, secondary dislocation, and skin breakdown over port septum.6,56,103 Overall, tunneled-cuffed CVADs and totally implantable venous devices had high insertion success rates55,59,87 and low failure rates,1,6 and can be used as alternatives to PICCs in patients requiring frequent vascular access.56 Given their high insertion success rate,87 nontunneled CVADs can be placed after the failed placement of other CVADs.56

    VAD Selection in Special Pediatric Populations

    Malignant Hematologic and Oncological Conditions

    For patients undergoing treatment of malignant hematologic and oncological conditions, infection and thrombotic complications, as well as disruption to treatment, are important considerations for VAD selection.25,119 A total of 17 studies, including 1 systematic review and 16 observational studies, and 5 CPGs were included. Most studies were focused on tunneled-cuffed CVADs and totally implantable venous devices in mixed hematology and oncology (n = 5), PN (n = 1), and leukemia (n = 3) populations. Other studies compared PICCs, CVADs, and totally implantable venous devices in mixed hematology and oncology populations (n = 5).

    Overall, tunneled-cuffed CVADs and totally implantable venous devices had low rates of insertion-related complications, device failure, and malfunction40,65,79,80,119,128 and were associated with low rates of thrombosis.2,112,132 Reporting on rates of infection between devices was variable. Two studies found that rates of infection were not statistically different between tunneled-cuffed CVADs and totally implantable venous devices.79,93 In contrast, other studies found higher rates of CLABSI in totally implantable venous devices compared to CVADs119 and higher risk of overall infection in totally implantable venous devices compared to tunneled-cuffed CVADs.128 Additional studies found that overall infection rates were higher in tunneled-cuffed CVADs compared to totally implantable venous devices.20,40,72,106 Although occlusion was common in this population,46,65,112,119 rates were not different between tunneled-cuffed CVAD and totally implantable venous devices.65,133 Compared to totally implantable venous devices and tunneled-cuffed CVADs, PICCs had higher rates of device-related complications as well as overall infection and CLABSI, thrombosis, and occlusion.2,40,112,138

    International guidelines recommend the use of tunneled-cuffed CVADs for pediatric patients undergoing hematologic and oncological treatment requiring frequent and continuous vascular access, particularly for frequent blood sampling, PN, and complex IV therapies.50,56 Totally implantable venous devices may also be appropriate across these indications,51 especially in patients ≥10 kg.45 These devices were only recommended for intermittent use, however, due to the increased risk of infection and thrombosis.45,50 One CPG endorsed the use of PICCs for short- to medium-term treatments,50 although there was insufficient evidence to support their routine use,117,120 and chemotherapy treatment via peripheral venous access was not recommended.50,120 No included studies reported on nontunneled CVADs; however, one international guideline supported the placement for intrahospital use or short durations only.50

    Critically Ill Patients

    Unlike other patient groups, for critically ill infants, children, and adolescents, choice of VAD may be prioritized by whether the patient is stable or unstable.21,22 Seven observational studies, 1 systematic review, and 1 RCT were included for critical care patients and included the emergency department (ED) (n = 2), emergency surgery (n = 1), moderate-severe burns (n = 1), out-of-hospital critical care (n = 1), and PICU (n = 4) populations. No studies explored midline devices in the critical care population, although one study compared short and long PIVCs.101 Overall, the focus of the studies in this population was on infection and thrombosis and not on outcomes such as dwell time, occlusion, infiltration, extravasation, or bleeding complications.

    Stable, Critically Ill Patients

    Regarding stable, critically ill patients requiring short-term acute therapy, 2 CPGs supported the use of nontunneled CVADs for any type of infusion therapy up to 7 to 10 days despite risk of infection and thrombosis.34,56 Evidence to support the use of PICCs in this population was mixed. Whereas the Infusion Therapy Standards of Practice cautioned against the use of PICCs in critically ill patients (adults and pediatrics) because of the risk of infection or thrombosis,66 2 other clinical guidelines recommended PICCs for both short-34,76 and long-term34 durations in critically ill patients. This variability may be due to the scarcity of high-quality evidence directly comparing these devices. PIVCs were frequently reported within this population101,137 and were recommended over intraosseous devices in nonemergent situations.21,22 However, compared to PICCs, PIVCs were commonly associated with obstruction, leakage, and dislodgment,137 with short PIVCs in particular linked to higher rates of local infections, dislocation, infiltration, occlusion, and thrombosis compared to long PIVCs.101 There were limited studies reporting on nontunneled CVAD use in critically ill children; however, authors of one study reported children >13 years old with a nontunneled CVAD were at higher risk of DVT compared with children <1 year.60 Tunneled-cuffed CVADs and totally implantable venous devices were associated with high rates of infection and thrombosis but were reported as suitable for long-term therapies in this population.34,73,111,115 No studies or CPGs reported on the suitability of midline devices in this population specifically, although they were more broadly considered appropriate for therapies lasting 1 to 4 weeks.76

    Unstable, Critically Ill Patients

    In unstable, critically ill patients, speed of access was prioritized. International guidelines recommend venous access via PIVC placement unless attempts to cannulate take >60 seconds or ≥2 attempts.21,22 When IV access was difficult, intraosseous devices were consistently reported as fast alternatives for children and adolescents,21,44,66,70,76,131 and umbilical catheter was recommended for neonates in the first week of age.22

    Congenital Cardiac Conditions

    For patients with congenital cardiac conditions, VAD selection prioritizes vessel preservation to ensure key vasculature can be used for future life-saving procedures.56 Overall, 3 CPGs and 4 observational studies of pediatric and young adult patients were included in the systematic review and encompassed patients with univentricular and biventricular physiology and patients in cardiac surgery subgroups. Comparisons between umbilical catheters, PICCs, tunneled CVADs, and nontunneled CVADs based on dwell time, occlusion, thrombosis, and infection risk were the primary focus of the included studies.15,31,35,88

    Generally, short-term peripheral and nonperipheral compatible therapy delivered via umbilical catheters in infants can be used.66 PICCs were recommended for patients with congenital cardiac conditions requiring ≥7 days of IV therapy.136 because of lower complication rates, PICCs inserted in lower extremity vessels were recommended.136 CVAD (tunneled and nontunneled) use was reported in this population; however, placement ≥7 days was associated with an increased risk of CLABSI.31,56 None of the included studies or guidelines included evidence to support the use of totally implantable venous devices in this population.

    Regarding specific use in neonates with univentricular physiology, umbilical catheters had low rates of CLABSI, thrombosis, and occlusion when compared to other devices,15 and they can be used when preventing significant vessel loss for future procedures is a prioirity. Although PICCs were generally recommended in congenital cardiac populations, clinical guidelines emphasized the need for specialist consultation for patients with cardiac malformations.136 Femoral nontunneled CVADs were reported as appropriate for therapies lasting <14 days in single-ventricle populations, with ≥14-day durations associated with a higher risk of thrombosis but not occlusion.15 Comparatively, other femoral devices (tunneled, uncuffed) were not related to an increased risk of thrombosis or occlusion for therapies lasting ≥14 days.15

    Long-term Vascular Access Dependent

    Long-term vascular access dependency encompassed nonmalignant hematologic, respiratory, gastrointestinal, metabolic, and immunologic conditions requiring long-term (>2 months) and very long-term (>1 year) VAD placement.29 In total, 4 studies and 9 CPGs described this diverse patient population across PN and non-PN therapies and continuous or intermittent therapies. Despite the heterogeneity of reported populations, vessel preservation and complication prevention were the common themes when comparing PICC, short- and long-catheter PIVC, midline, tunneled-cuffed CVAD, and totally implantable venous device indications.16,32,90,109

    Long-term PN Infusates

    CLABSI, occlusion, and thrombosis were common complications of long-term PN therapy across all VADs.16,32 Peripheral devices (PIVCs and midlines) are unsafe for delivering PN because of the risk of venous damage50,62,66; however, they may be indicated for limited time periods in hospitalized patients with restricted dextrose and protein concentrations (<10% and/or 5%, respectively).66,76,107 One single-center observational study supported PICCs for long-term PN,32 and another CPG recommended PICCs for home PN107; although totally implantable venous devices were generally preferred when PN was required for long durations, despite being associated with an increased risk of infection.16,29,32,50,56,92

    Long-term Non-PN Infusates

    Evidence for the use of VADs in patients requiring long-term non-PN infusates was similar. Specifically, except for in one CPG, all peripheral devices (PIVCs and midlines) were regarded as inappropriate for long-term–dependent non-PN therapies, especially in patients with chronic renal failure.56,62,66,76,109 Tunneled CVADs and totally implantable venous devices were instead preferred for non-PN therapies required for continuous or intermittent and extended durations, respectively.56,62,66,76,103,109

    Difficult Venous Access

    For pediatric patients with difficult venous access, insertion success rates and the number of attempts are priority considerations for VAD selection. Factors that affect these include patient physiology, pathology, damage caused by VAD, and the procedural skill of the clinician.144 Five observational studies were included for patients with difficult venous access in ED (n = 2), elective surgery (n = 1), PICU (n = 1), and hospitalized children (n = 1) populations. The majority of studies compared nontunneled CVADs (n = 3) and evaluated the insertion success rates and complications associated with the number of insertion attempts. Two studies evaluated PIVCs with and without ultrasound-guided (USG) techniques in pediatric populations.123,130

    In patients with difficult vascular access, USG PIVC insertion was associated with higher overall and first- and second-attempt success rates after failed insertion via the landmark method.130 Up to 17.2% of CVADs in an ED setting experienced a complication (arterial puncture, hematoma, pneumothorax, and arrhythmia), and ≥3 attempts were significantly related to complication development.140 In a study comparing insertion success in neonates and nonneonates, nontunneled CVAD failure was common (63.1%–76.3%), and the success rate after >1 attempts was significantly lower with decreasing patient age and associated with greater insertion-related complications.55 Similarly, nontunneled CVAD placement in PICU patients led to high early mechanical complications (17.5%) and was associated with more insertion attempts and insertion using the subclavian or jugular approach.113

    Recommendations Regarding Device Characteristics

    Catheter-to-Vein Ratio

    Determining the appropriate catheter-to-vein ratio is a difficult balancing act of optimizing patient and therapy needs while ensuring risk of catheter-related complications, such as occlusion, is minimized. Although catheter-to-vein ratio was recognized as important for preventing phlebitis, occlusion, and thrombosis,56 few studies reported on catheter-to-vein ratios in neonate and pediatric patients. Only one observational study reported on PICCs in hospitalized children91; therefore the included studies were broadened to incorporate an adult and laboratory study.95,118 An additional 6 CPGs were referred to for guidance.34,50,56,66,82,136

    Clinical guidelines emphasized selecting the smallest practical sized gauge or French (F) that met treatment and patient need.34,56,66,95,136 Inadequate catheter-to-vein ratio was linked to an increased risk of thrombosis in 2 studies, especially in infants with congenital heart disease, and smaller catheter size was associated with higher rates of occlusion.50,56 In contrast, larger catheters had a corresponding increase in rates of phlebitis.66 For any VAD (PICC, PIVC, midline, CVAD, or totally implantable venous device) a catheter-to-vein ratio of <50% in pediatric patients and <33% in neonates was generally recommended.56,66,136 Specific to PICCs, thrombosis risk increased with a catheter-to-vein ratio ≥0.3391 and ≥0.45,118 in hospitalized children and adults, respectively. Depending on the patient vessel size, 22- to 24-gauge peripheral catheters were considered appropriate for both pediatric patients and neonates.66,76 According to the Peripherally Inserted Central Catheters: Guideline for Practice from the National Association of Neonatal Nurses, 1.1F to 3F catheters (20–28 gauge) were commonly used catheter sizes for neonates.136 There were no specific recommendations or empirical evidence for the size of CVADs (tunneled or nontunneled), midline catheters, or totally implantable venous devices.

    Device Lumens

    Choosing the optimum number of device lumens to deliver planned therapy while reducing the risk of catheter-associated complications, particularly infection, occlusion, and thrombosis, is both complex and important.34 Nine studies described lumen number outcomes in hospitalized adult (n = 2), children (n = 2) and infant (n = 1), immune-competent (n = 1), and hematology and oncology (n = 3) populations. An additional 11 CPG recommendations were included in the review. All compared single- versus double- or multilumen catheters in CVADs (n = 3), tunneled-cuffed CVADs (n = 2), and PICCs (n = 4).

    Universally, CPGs recommended the minimum number of lumens necessary for therapy provision. Because of increased risk of infection, occlusion, and thrombosis, multilumen VADs are only appropriate when indicated (ie, for hematopoietic stem cell transplant, critically ill patients, and patients requiring concurrent infusion of noncompatible infusates such as blood and blood product, PN, or chemotherapy).* A dedicated lumen for PN was also frequently endorsed,34,50,86,107 but authors of 2 CPGs stated there was insufficient evidence to support this recommendation.56,96 Similarly, a dedicated lumen for blood sampling, through the largest lumen, was recommended by some, but with limited evidence.66,76

    Evidence evaluating multilumen PICC outcomes was mixed. One study found DVT risk increased with ≥2 lumens,67 another study reported a nonsignificant reduction in CLABSI risk with single-lumen use,39 while a number of other studies reported that PICC lumen number was not significantly associated with the risk of thrombosis81,122 or infection.81 Overall, most studies found occlusion was the most common complication associated with catheter lumen number, and ≥2 lumen PICCs were associated with the highest risk of occlusion.28,39,81 Similarly, studies reported mixed outcomes on the basis of CVAD lumen number. Two studies reported no association between single- and double-lumen catheters and rates of infection65 and major CVAD-related complications,26 whereas others reported higher rates of CLABSI,46,106 exit-site or tunnel infection,46 malfunction or occlusion,46 and complications requiring repositioning26 for double-lumen CVADs.

    Recommendations for Insertion

    Insertion Locations

    Optimal catheter site selection in pediatric patients is more complex than in adults as pediatric patients typically have fewer accessible veins due to their smaller size.56,124 Determining the appropriate insertion site is important for minimizing risk of insertion and preventing post-insertion related complications19,56,75,86,124; however, only partial evidence for appropriate vessels and insertion locations for VADs was available. A total of 21 studies and 12 CPGs were included describing insertion location outcomes. Overall, most studies (n = 15) compared CVADs in cardiac, neurology, and general surgical (n = 5), PICU (n = 4), hospitalized infant (n = 1), oncology (n = 1), and stem cell collection (n = 1) populations. Five studies compared PIVC device location in surgical (n = 3), hospitalized children (n = 1), and neonate and infant (n = 1) populations, and 3 studies evaluated PICC device location in oncology (n = 1), hospitalized children (n = 1), and immunocompetent (n = 1) populations.

    According to the guidelines reviewed, common insertion sites varied by device type. PIVC insertion was frequently recommended in the hand and upper extremities,66,76 with the scalp and foot suggested as alternative insertion sites for infants and toddlers.66 The Infusion Therapy Standards of Practice66 and Provisional Infusion Therapy Standards of Practice76 guidelines recommended avoidance of areas of flexion including the wrist. Insertion of PICCs via the basilic vein was the preferred insertion site, although the brachial, cephalic, axillary, temporal, and posterior auricular veins were acceptable alternatives.56,62,66,76,107 For neonates, the best available vein was recommended without specific guidance as to what constituted the best vein.66 Infants could also have PICCs inserted at saphenous and popliteal veins.56,66,76 Similarly, for midline catheter insertion, the basilic, brachial, and cephalic veins were suggested for neonates, infants, and pediatric patients,76,96 as well as alternative insertion sites such as the scalp and leg.66,76 For PIVCs, the external jugular vein was recommended only in emergency settings or if no other vein was available.66 Overall, there were no preferred insertion sites for tunneled and nontunneled CVADs or totally implantable vascular devices in neonates, infants, and pediatric patients.66,76,82,117,120 No studies evaluated the insertion locations for tunneled and nontunneled CVADs in children; however, in adults, tunneled and nontunneled CVADs were commonly inserted into the internal and external jugular, subclavian, or femoral vein, although the subclavian vein was the recommended insertion site.56,62,76,107

    Insertion Success Is Dependent on Vessel and Insertion Site

    PIVCs had higher success rates when inserted in the cephalic vein in the proximal forearm under USG techniques or the antecubital fossa109,123 and a longer life span when inserted into the arm compared to scalp, hand, or leg insertion sites.33 CVAD insertion via the axillary vein using USG techniques resulted in fewer insertion attempts and significantly shorter time to guide-wire insertion and time to cannulation.78 Similarly, CVAD insertion in the subclavian vein was associated with shorter median puncture time, less insertion attempts, and significantly less guide-wire misplacement compared to insertion via the infraclavicular approach.41 In one study, there was higher overall insertion success for insertion via the subclavian compared to the internal jugular vein when using the landmark technique.42 In a sample of critically ill newborns and children (0–14 years), USG brachiocephalic insertion had significantly higher first-attempt success, fewer insertion attempts, and a shorter procedure time compared to the internal jugular vein.98 In critically ill neonates and infants, image-guided placement of tunneled CVADs via saphenous or femoral veins using a surgical cutdown was associated with high placement success.63

    Complications Are Associated With Vessel and Insertion Site

    In pediatric patients, PIVCs inserted at the bend of the arm or lower extremities were associated with increased risk of infiltration, erythema, pain, inability to administer medications, no or poor flow due to gravity, and kinked catheter,125,127 whereas insertion at the foot, ankle, or scalp was significantly associated with increased risk of occlusion.125,127 In neonates and infants, PICC insertion at foot or ankle sites was significantly associated with an increased risk of phlebitis, thrombosis, and dysfunction.47,125,136 Overall, there was no direct association between PICC insertion at brachial, cephalic, or saphenous insertion sites and thrombosis in pediatric patients122; however, left-sided PICC insertion was associated with higher rates of PICC-related complications.37 The majority of studies, with 2 exceptions,18,78 found that rates of infection and complication varied significantly on the basis of CVAD insertion sites.† Generally, complications were similar between internal jugular and subclavian veins.42 One study, however, reported higher rates of early mechanical complications in nontunneled CVADs inserted through the subclavian compared to the jugular or femoral vein.113

    Across CVAD types, insertion via the internal jugular in infants and pediatric patients was associated with increased risk of high arterial puncture,42,113 postoperative chylothorax,36 thrombosis,67,69,89 and infection.42,69 Insertion through the subclavian vein was correlated with an increased risk of high arterial puncture (left-side approaches),42,113 arrhythmias and misplacement (right-side approaches),113 malposition and occlusion,42 postoperative chylothorax,36 and sepsis.31 In pediatric oncology patients, subclavian insertion sites had higher rates of thrombosis compared to external jugular and cephalic sites, but there was no difference in rates between right- or left-side insertion sites.132 Comparatively, brachiocephalic insertion sites were associated with significantly lower CLABSI and thrombosis compared to jugular and subclavian approaches.69 Overall, CVAD insertion through the femoral vein was linked to higher risk of thrombosis51,67,89 but lower complication and infection rates in infants <5 kg.85

    Vessel Visualization

    Vessel and catheter-tip visualization technologies, including ultrasound guidance, transillumination, near-infrared (NIR) light device guidance, fluoroscopy, and electrocardiogram (ECG), are commonly used in pediatric clinical practice.34,82 Despite the variety of available technologies, all vessel visualization technologies aim to minimize complications and increase success rates during cannulation. Overall, 31 studies describing vessel visualization outcomes for PIVC, midline, PICC, CVAD, and totally implantable venous devices and 15 CPGs were included. Among those, 17 studies were focused on VADs in critically ill children, neonate, and infant (n = 4); hospitalized children (n = 3); cardiac, neurologic, and general surgical (n = 3); mixed cardiac surgical, congenital heart disease, and PICU (n = 1); ED (n = 1); and neonate (n = 1) populations. Across these heterogeneous populations, the focus was on increasing first-attempt success rates and overall successful insertion and correct catheter-tip positioning.

    Across all CPGs, USG insertion by trained clinicians was recommended for all pediatric populations, device types, and insertion sites.‡ It was indicated in most of the evidence reviewed that USG insertions were associated with high insertion success, first-attempt success rates, lower procedure time, fewer attempts, and fewer complications in PIVCs and CVADs.§ Only 2 systematic reviews reported no difference in CVAD insertion success rates between ultrasound guidance and landmark techniques.121,135 PIVC insertion was frequently improved by use of vessel visualization devices,101,123,130 with fewer complications noted.101 Few studies compared visualization techniques for totally implantable venous device placement. One study reported USG percutaneous puncture of totally implantable venous devices had similar success rates, procedure times, and complication rates when compared to surgical cutdown methods.48 Another study found that insertion of totally implantable venous devices by using ultrasound guidance was significantly more effective in reducing complication rates, had shorter procedure times, and was more cost-efficient compared to open surgical cutdown techniques.71

    However, recommendations for other visualization techniques in pediatric populations, including NIR light (vessel visualization) and ECG (catheter-tip confirmation) device use, were scant. Use of NIR light devices may be efficacious in selected high-risk subpopulations102 and may modestly improve first-attempt success rates77,104,110; however, the current evidence does not support an overall benefit74 or a benefit that is better than non–image-guided methods.104 Similarly, low levels of evidence prevent the recommendation of ECG assistance for PICC placement105; however, one study also found higher first-attempt success and correct tip position success by using intracavitary ECG PICC insertion compared to landmark techniques.141 Other techniques, such as ECG techniques, for CVAD placement were reported as successful and accurate.27,116 In particular, the ECG technique was significantly more accurate and was associated with fewer complications when compared to landmark techniques27 and when intracavitary ECG was undertaken by using a dedicated ECG monitor.116 An article discussed vessel visualization techniques for umbilical catheters and recommended plain radiographs for confirming catheter course and location.142

    Discussion

    VAD selection and insertion grounded in evidence-based, standardized decision-making can reduce risk of complications, pain, length of hospital stay, and costs and can improve overall safety and treatment efficacy.1–6 Despite many individual studies, systematic reviews, and targeted CPGs, there is no evidence-based guide to assist clinical decision-making in common pediatric indications. This systematic review is the first of its kind to evaluate the evidence that informs VAD selection and insertion for common pediatric indications by using rigorous methodology and a wide breadth of scope. Overall, our review synthesized the available high-quality evidence to inform clinical decision-making, while also highlighting practices in need of further inquiry.

    This systematic review revealed evidence- and guideline-based recommendations for VAD selection and insertion in numerous pediatric populations.56,66,76,136 There was a large quantity of evidence to support VAD selection and insertion decision-making in general hospitalized pediatric patients and specialized populations, such as malignant hematologic and oncological and critically ill pediatric patients. Use of most VADs and their associated complications, especially for PICCs, was well evidenced within these population groups. Evidence to support the use of single-lumen devices unless otherwise indicated (eg, for PN) was broadly supported within the literature and in CPGs.‖ Similarly, evidence to suggest that VAD insertion assisted by USG techniques reduced complications and improved insertion success was repeatedly reported by high-quality studies and recommended across multiple CPGs. The strength of the evidence for device selection and insertion in these populations therefore facilitates the implementation of quality clinical decision-making.

    On the other hand, our review highlighted gaps in evidence, especially in the form of RCTs, for some pediatric populations, devices, and indications. In some pediatric populations, evidence was so sparse that the scope of the review had to be broadened to include adult and laboratory studies. Specific populations, such as neonates, cardiac patients, and patients with difficult venous access, relied on a few observational studies, making recommendations on device selection challenging. Similarly, although there was a significant proportion of quality evidence on VADs in patients dependent on long-term PN, there was limited evidence for other long-term VAD-dependent populations (eg, cystic fibrosis). Universally, there was a dearth of evidence evaluating midline catheters for the majority of pediatric indications. The literature for recommendations regarding optimal catheter-to-vein ratio was also limited; therefore, this review had to be broadened to include adult and laboratory studies. Finally, although there was abundant evidence to support use of USG techniques for the majority of device insertions, there was a shortage of evidence for the use of other technologies, particularly NIR light devices. As such, additional high-quality research evaluating these populations, device types and characteristics, and insertion procedures is warranted.

    Although this study undertook a systematic and rigorous review of the available literature, the results should be interpreted with caution and in the context of its limitations. First, we did not undertake formal assessment of the quality of evidence (eg, using the Grading of Recommendations Assessment, Development and Evaluation [GRADE] approach); however, all individual included studies were independently assessed by 2 review authors, and their quality indicated by their study methodology, in accordance with the RAND-UCLA methodology.9 Additionally, although this study prioritized the review of RCTs and systematic reviews as the gold standard for evaluating VADs, this level of evidence was rarely available. In accordance with the RAND-UCLA Appropriateness Method, the purpose of this review was to include the best available evidence to provide a synthesis of information to guide panel decision-making.9 To avoid indications for which there was no evidence, we included evidence from lower-quality studies (eg, cross-sectional studies, surveillance studies, consecutive cases) and studies outside the initial scope of this review (NICU, adult, and laboratory studies). The inclusion of these studies for some indications means that future clinical decision-making in certain pediatric populations is not guided by strong, evidence-based recommendations. However, most of the evidence that was broadened beyond the original scope of the systematic review was well supported by CPGs, suggesting that these findings can be implemented into clinical practice with confidence.

    Conclusions

    In this systematic review, we provide the first synthesis of the breadth of evidence available for the selection and insertion of VADs in pediatric patients to guide clinical decision-making. There was strong evidence to support and facilitate appropriate clinical decision-making in some pediatric indications. However, certain populations, device types and characteristics, and insertion procedures were poorly evidenced, necessitating the application of clinical judgment for some indications. Overall, the findings of this review will be vital to inform criteria using the RAND-UCLA Appropriateness Method to determine the appropriateness of VADs in pediatric patients.

    Footnotes

      • Accepted January 21, 2020.
    • Address correspondence to Amanda J. Ullman, RN, PhD, School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Kessels Rd, Nathan, QLD 4111, Australia. E-mail: a.ullman{at}griffith.edu.au

    • * Refs 34,50,51,56,62,66,76,86,107,124.

    • † Refs 136–50,56,62,66,75,76,82,96,107,108,117–38.

    • ‡ Refs 28,34,39,46,50,56,62,66,76,86,106,107,124–26.

    • § Refs 136–26,50,56,62,66,75,76,78,82,96,107,108,117–83.

    • ↵† Refs 31, 36, 42, 49, 67, 69, 85, 89, 113, and 132.

    • ↵§ Refs 17, 26, 52, 53, 61, 63, 64, 68, 78, 83, 99, 114, 129, and 139.

    • ↵* Refs 34, 50, 51, 56, 62, 66, 76, 86, 107, and 124.

    • ↵‡ Refs 34, 38, 50, 56, 62, 66, 75, 76, 82, 96, 107, 108, 117, 126, and 136.

    • ↵‖ Refs 26, 28, 34, 39, 46, 50, 56, 62, 66, 76, 81, 86, 106, 107, and 124.

    • ↵ Refs 17, 26, 34, 38, 50, 52, 53, 56, 61, 62, 64, 66, 68, 75, 76, 78, 82, 83, 96, 99, 107, 108, 114, 117, 126, 129, 136, and 139.

    • FINANCIAL DISCLOSURE: Dr Paterson reports employment from Griffith University and The University of Queensland. Dr Chopra reports grants from the Agency for Healthcare Research and Quality, American Hospital Association; book royalties from Oxford University Publishing for The Saint-Chopra Guide to Inpatient Medicine; and honoraria for invited external talks as visiting professor. Dr Brown reports employment from Griffith University. Ms Kleidon reports employment by Queensland Health; grants from the Children’s Hospital Foundation, the National Health and Medical Research Council (NHMRC), and Emergency Medicine Foundation; and investigator-initiated research grants and speaker fees provided to Griffith University from 3M Medical; AngioDynamics; Baxter; BD-Bard; Centurion Medical Products; Cook Medical; Medical Specialties Australasia, Smiths Medical; and Vygon (unrelated to the current project). Prof Cooke reports employment from Griffith University and grants from Griffith University, the Children’s Hospital Foundation, Royal Brisbane and Women’s Hospital Foundation, Cancer Council Queensland, Australasian College for Infection Prevention and Control, and investigator-initiated research grants and speaker fees provided to Griffith University by vascular access product manufacturers (Baxter, BD, Entrotech Life Sciences) unrelated to this project. Prof Rickard reports a fellowship from Queensland Health; employment from Griffith University; and grants from NHMRC, Griffith University, the Children’s Hospital Foundation, Princess Alexandra Hospital Foundation, Royal Brisbane and Women’s Hospital Foundation, American Society for Parenteral and Enteral Nutrition Rhoads Foundation, Cancer Council Queensland, Australasian College for Infection Prevention and Control, Association for Vascular Access Foundation, Australian College of Nursing, Australian College of Critical Care Nurses, and Emergency Medicine Foundation; and investigator-initiated research grants and speaker fees provided to Griffith University by vascular access product manufacturers (3M Medical, AngioDynamics, Baxter, B. Braun Medical, BD-Bard, Medtronic, ResQDevices, Smiths Medical) unrelated to this project. Dr Bernstein reports grants from the Agency for Healthcare Research and Quality and US Department of Veterans Affairs. Dr Ullman reports fellowships and grants from the NHMRC; employment from Griffith University; grants by the Children’s Hospital Foundation, Royal Brisbane and Women’s Hospital Foundation, Emergency Medicine Foundation, and Australian College of Critical Care Nurses; and investigator-initiated research grants and speaker fees provided to Griffith University from 3M Medical, AngioDynamics, and BD (unrelated to the current project). Dr Ullman also reports investigator-initiated research grants and speaker fees provided to Griffith University from vascular access product manufacturers (3M Medical, AngioDynamics, BD, Cardinal Health) unrelated to the current project.

    • FUNDING: Supported by grants from the Association for Vascular Access Foundation, Griffith University, and the University of Michigan.

    • POTENTIAL CONFLICT OF INTEREST: Dr Chopra reports grants from the Agency for Healthcare Research and Quality, American Hospital Association; book royalties from Oxford University Publishing for The Saint-Chopra Guide to Inpatient Medicine; and honoraria for invited external talks as visiting professor. Ms Kleidon reports investigator-initiated research grants and speaker fees provided to Griffith University from 3M Medical; AngioDynamics; Baxter; BD-Bard; Centurion Medical; Cook Medical; Medical Specialties Australasia; and Vygon (unrelated to the current project). Prof Cooke reports investigator-initiated research grants and speaker fees provided to Griffith University by vascular access product manufacturers (Baxter, BD, Entrotech Life Sciences) unrelated to this project. Prof Rickard reports investigator-initiated research grants and speaker fees provided to Griffith University from vascular access product manufacturers (3M Medical; AngioDynamics; Baxter; B. Braun; BD-Bard; Medtronic; ResQDevices; Smiths Medical) unrelated to this project. Dr Bernstein reports grants from the Agency for Healthcare Research and Quality and the US Department of Veterans Affairs. Dr Ullman reports investigator-initiated research grants and speaker fees provided to Griffith University from vascular access product manufacturers (3M Medical, AngioDynamics, and BD) unrelated to the current project. Drs Paterson and Brown have indicated they have no potential conflicts of interest to disclose.

    References

    1. ↵
      1. Ullman AJ,
      2. Cooke M,
      3. Kleidon T,
      4. Rickard CM
      . Road map for improvement: point prevalence audit and survey of central venous access devices in paediatric acute care. J Paediatr Child Health. 2017;53(2):123–130
      OpenUrl
    2. ↵
      1. Noailly Charny PA,
      2. Bleyzac N,
      3. Ohannessian R,
      4. Aubert E,
      5. Bertrand Y,
      6. Renard C
      . Increased risk of thrombosis associated with peripherally inserted central catheters compared with conventional central venous catheters in children with leukemia. J Pediatr. 2018;198:46–52
      OpenUrl
      1. LaRusso K,
      2. Schaack G,
      3. Fung T, et al
      . Should you pick the PICC? Prolonged use of peripherally inserted central venous catheters in children with intestinal failure. J Pediatr Surg. 2019;54(5):999–1004
      OpenUrl
      1. Gibson C,
      2. Connolly BL,
      3. Moineddin R,
      4. Mahant S,
      5. Filipescu D,
      6. Amaral JG
      . Peripherally inserted central catheters: use at a tertiary care pediatric center. J Vasc Interv Radiol. 2013;24(9):1323–1331
      OpenUrlCrossRefPubMed
    5. ↵
      1. Noonan PJ,
      2. Hanson SJ,
      3. Simpson PM,
      4. Dasgupta M,
      5. Petersen TL
      . Comparison of complication rates of central venous catheters versus peripherally inserted central venous catheters in pediatric patients. Pediatr Crit Care Med. 2018;19(12):1097–1105
      OpenUrlCrossRef
    6. ↵
      1. Ullman AJ,
      2. Marsh N,
      3. Mihala G,
      4. Cooke M,
      5. Rickard CM
      . Complications of central venous access devices: a systematic review. Pediatrics. 2015;136(5). Available at: www.pediatrics.org/cgi/content/full/136/5/e1331
    7. ↵
      1. Ullman AJ,
      2. Chopra V,
      3. Brown E, et al
      . Developing appropriateness criteria for pediatric vascular access. Pediatrics. 2020;145(suppl 3):e20193474G
      OpenUrl
    8. ↵
      1. Ullman AJ,
      2. Bernstein SJ,
      3. Brown E, et al
      . The Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics: miniMAGIC. Pediatrics. 2020;145(suppl 3):e20193474I
      OpenUrl
    9. ↵
      1. Fitch K,
      2. Bernstein SJ,
      3. Aguilar MD, et al
      . The RAND/UCLA Appropriateness Method User’s Manual. Santa Monica, CA: RAND Corporation; 2001
    10. ↵
      1. Brown E,
      2. Ullman A
      . Which vascular access devices are most likely to promote function and least likely to cause harm and under which circumstances in paediatrics? PROSPERO 2019 CRD42019094286. Available at: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=94286. Accessed April 27, 2020
    11. ↵
      1. Moher D,
      2. Liberati A,
      3. Tetzlaff J,
      4. Altman DG; PRISMA Group
      . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535
      OpenUrlFREE Full Text
    12. ↵
      1. von Elm E,
      2. Altman DG,
      3. Egger M,
      4. Pocock SJ,
      5. Gøtzsche PC,
      6. Vandenbroucke JP; STROBE Initiative
      . Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806–808
      OpenUrlFREE Full Text
    13. ↵
      1. Critical Appraisal Skills Programme
      . 2018. CASP (Cohort Study) Checklist. [Online]. Available at: https://casp-uk.net/wp-content/uploads/2018/01/CASP-Cohort-Study-Checklist_2018.pdf. Accessed June 1, 2018
    14. ↵
      1. Adams DZ,
      2. Little A,
      3. Vinsant C,
      4. Khandelwal S
      . The midline catheter: a clinical review. J Emerg Med. 2016;51(3):252–258
      OpenUrl
    15. ↵
      1. Aiyagari R,
      2. Song JY,
      3. Donohue JE,
      4. Yu S,
      5. Gaies MG
      . Central venous catheter-associated complications in infants with single ventricle: comparison of umbilical and femoral venous access routes. Pediatr Crit Care Med. 2012;13(5):549–553
      OpenUrlCrossRefPubMed
    16. ↵
      1. Ainsworth S,
      2. McGuire W
      . Percutaneous central venous catheters versus peripheral cannulae for delivery of parenteral nutrition in neonates. Cochrane Database Syst Rev. 2015;(10):CD004219
      1. Alten JA,
      2. Borasino S,
      3. Gurley WQ,
      4. Law MA,
      5. Toms R,
      6. Dabal RJ
      . Ultrasound-guided femoral vein catheterization in neonates with cardiac disease. Pediatr Crit Care Med. 2012;13(6):654–659
      OpenUrlPubMed
    18. ↵
      1. Anil AB,
      2. Anil M,
      3. Kanar B, et al
      . The evaluation of central venous catheterization complications in a pediatric intensive care unit. Turk Pediatri Ars. 2011;46:215–219
      OpenUrl
    19. ↵
      1. Australian and New Zealand Intensive Care Society
      . Central Line Insertion and Maintenance Guideline. Melbourne, Australia: Australian and New Zealand Intensive Care Society Safety and Quality Committee; 2012
    20. ↵
      1. Allen RC,
      2. Holdsworth MT,
      3. Johnson CA, et al
      . Risk determinants for catheter-associated blood stream infections in children and young adults with cancer. Pediatr Blood Cancer. 2008;51(1):53–58
      OpenUrlCrossRefPubMed
    21. ↵
      1. Australian Resuscitation Council
      2. New Zealand Resuscitation Council
      . Advanced life support for infants and children diagnosis and management. ARC and NZRC Guideline 2010. Emerg Med Australas. 2011;23(4):400–402
      OpenUrlPubMed
    22. ↵
      1. Australian Resuscitation Council
      2. New Zealand Resuscitation Council
      . Medication or fluids for the resuscitation of the newborn infant. ARC and NZRC Guideline 2010. Emerg Med Australas. 2011;23(4):442–444
      OpenUrlPubMed
    23. ↵
      1. Australian Resuscitation Council
      2. New Zealand Resuscitation Council
      . Techniques in Paediatric Advanced Life Support. ARC and NZRC Guideline 2010. Emerg Med Australas. 2011;23(4):412–416
      OpenUrlPubMed
    24. ↵
      1. Arnts IJ,
      2. Bullens LM,
      3. Groenewoud JM,
      4. Liem KD
      . Comparison of complication rates between umbilical and peripherally inserted central venous catheters in newborns. J Obstet Gynecol Neonatal Nurs. 2014;43:205–215
      OpenUrlCrossRefPubMed
    25. ↵
      1. Athale UH,
      2. Siciliano S,
      3. Cheng J,
      4. Thabane L,
      5. Chan AKC
      . Central venous line dysfunction is an independent predictor of poor survival in children with cancer. J Pediatr Hematol Oncol. 2012;34(3):188–193
      OpenUrlCrossRefPubMed
    26. ↵
      1. Avanzini S,
      2. Mameli L,
      3. Disma N, et al
      . Brachiocephalic vein for percutaneous ultrasound-guided central line positioning in children: a 20-month preliminary experience with 109 procedures. Pediatr Blood Cancer. 2017;64(2):330–335
      OpenUrl
    27. ↵
      1. Barnwal NK,
      2. Dave ST,
      3. Dias R
      . A comparative study of two techniques (electrocardiogram- and landmark-guided) for correct depth of the central venous catheter placement in paediatric patients undergoing elective cardiovascular surgery. Indian J Anaesth. 2016;60(7):470–475
      OpenUrl
    28. ↵
      1. Barrier A,
      2. Williams DJ,
      3. Connelly M,
      4. Creech CB
      . Frequency of peripherally inserted central catheter complications in children. Pediatr Infect Dis J. 2012;31(5):519–521
      OpenUrlCrossRefPubMed
    29. ↵
      1. Baskin KM,
      2. Mermel LA,
      3. Saad TF, et al; Venous Access: National Guideline and Registry Development (VANGUARD) Initiative Affected Persons Advisory Panel
      . Evidence-based strategies and recommendations for preservation of central venous access in children. JPEN J Parenter Enteral Nutr. 2019;43(5):591–614
      OpenUrl
    30. ↵
      1. Ben Abdelaziz R,
      2. Hafsi H,
      3. Hajji H, et al
      . Peripheral venous catheter complications in children: predisposing factors in a multicenter prospective cohort study [published correction appears in BMC Pediatr. 2018;18(1):307]. BMC Pediatr. 2017;17(1):208
      OpenUrl
    31. ↵
      1. Bezzio S,
      2. Scolfaro C,
      3. Broglia R, et al
      . Prospective incidence study of bloodstream infection in infants and children with central venous catheters after cardiac surgery in Italy. Infect Control Hosp Epidemiol. 2009;30(7):698–701
      OpenUrlCrossRefPubMed
    32. ↵
      1. Blotte C,
      2. Styers J,
      3. Zhu H,
      4. Channabasappa N,
      5. Piper HG
      . A comparison of Broviac® and peripherally inserted central catheters in children with intestinal failure. J Pediatr Surg. 2017;52(5):768–771
      OpenUrl
    33. ↵
      1. Birhane E,
      2. Kidanu K,
      3. Kassa M, et al
      . Lifespan and associated factors of peripheral intravenous cannula among infants admitted in public hospitals of Mekelle city, Tigray, Ethiopia, 2016. BMC Nurs. 2017;16:33
      OpenUrl
    34. ↵
      1. Bodenham Chair A,
      2. Babu S,
      3. Bennett J, et al
      . Association of Anaesthetists of Great Britain and Ireland: safe vascular access 2016 [published correction appears in Anaesthesia. 2016;71(12):1503]. Anaesthesia. 2016;71(5):573–585
      OpenUrlCrossRefPubMed
    35. ↵
      1. Boe BA,
      2. Zampi JD,
      3. Yu S,
      4. Donohue JE,
      5. Aiyagari R
      . Transhepatic central venous catheters in pediatric patients with congenital heart disease. Pediatr Crit Care Med. 2015;16(8):726–732
      OpenUrl
    36. ↵
      1. Borasino S,
      2. Diaz F,
      3. El Masri K,
      4. Dabal RJ,
      5. Alten JA
      . Central venous lines are a risk factor for chylothorax in infants after cardiac surgery. World J Pediatr Congenit Heart Surg. 2014;5(4):522–526
      OpenUrlCrossRefPubMed
    37. ↵
      1. Borretta L,
      2. MacDonald T,
      3. Digout C,
      4. Smith N,
      5. Fernandez CV,
      6. Kulkarni K
      . Peripherally inserted central catheters in pediatric oncology patients: a 15-year population-based review from Maritimes, Canada. J Pediatr Hematol Oncol. 2018;40(1):e55–e60
      OpenUrl
    38. ↵
      1. Bouaziz H,
      2. Zetlaoui PJ,
      3. Pierre S, et al
      . Guidelines on the use of ultrasound guidance for vascular access. Anaesth Crit Care Pain Med. 2015;34(1):65–69
      OpenUrl
    39. ↵
      1. Bozaan D,
      2. Skicki D,
      3. Brancaccio A, et al
      . Less lumens-less risk: a pilot intervention to increase the use of single-lumen peripherally inserted central catheters. J Hosp Med. 2019;14(1):42–46
      OpenUrl
    40. ↵
      1. Bratton J,
      2. Johnstone PA,
      3. McMullen KP
      . Outpatient management of vascular access devices in children receiving radiotherapy: complications and morbidity. Pediatr Blood Cancer. 2014;61(3):499–501
      OpenUrlCrossRefPubMed
    41. ↵
      1. Byon HJ,
      2. Lee GW,
      3. Lee JH, et al
      . Comparison between ultrasound-guided supraclavicular and infraclavicular approaches for subclavian venous catheterization in children--a randomized trial. Br J Anaesth. 2013;111(5):788–792
      OpenUrlCrossRefPubMed
    42. ↵
      1. Camkiran Firat A,
      2. Zeyneloglu P,
      3. Ozkan M,
      4. Pirat A
      . A randomized controlled comparison of the internal jugular vein and the subclavian vein as access sites for central venous catheterization in pediatric cardiac surgery. Pediatr Crit Care Med. 2016;17(9):e413–e419
      OpenUrl
    43. ↵
      1. Campagna S,
      2. Gonella S,
      3. Zerla PA, et al
      . The risk of adverse events related to extended-dwell peripheral intravenous access. Infect Control Hosp Epidemiol. 2018;39(7):875–877
      OpenUrl
    44. ↵
      1. Carlson JN,
      2. Gannon E,
      3. Mann NC, et al
      . Pediatric out-of-hospital critical procedures in the United States. Pediatr Crit Care Med. 2015;16(8):e260–e267
      OpenUrl
    45. ↵
      1. Carraro F,
      2. Cicalese MP,
      3. Cesaro S, et al
      . Guidelines for the use of long-term central venous catheter in children with hemato-oncological disorders. On behalf of Supportive Therapy Working Group of Italian Association of Pediatric Hematology and Oncology (AIEOP). Ann Hematol. 2013;92(10):1405–1412
      OpenUrlCrossRefPubMed
    46. ↵
      1. Cesaro S,
      2. Cavaliere M,
      3. Pegoraro A,
      4. Gamba P,
      5. Zadra N,
      6. Tridello G
      . A comprehensive approach to the prevention of central venous catheter complications: results of 10-year prospective surveillance in pediatric hematology-oncology patients. Ann Hematol. 2016;95(5):817–825
      OpenUrl
    47. ↵
      1. Chen H,
      2. Zhang X,
      3. Wang H,
      4. Hu X
      . Complications of upper extremity versus lower extremity placed peripherally inserted central catheters in neonatal intensive care units: a meta-analysis. Intensive Crit Care Nurs. 2020;56:102753
      OpenUrl
    48. ↵
      1. Choi JS,
      2. Park KM,
      3. Jung S, et al
      . Usefulness of percutaneous puncture in insertion of totally implantable venous access devices in pediatric patients. Vasc Spec Int. 2017;33(3):108–111
      OpenUrl
      1. Cooling L,
      2. Hoffmann S,
      3. Webb D,
      4. Yamada C,
      5. Davenport R,
      6. Choi SW
      . Performance and safety of femoral central venous catheters in pediatric autologous peripheral blood stem cell collection. J Clin Apher. 2017;32(6):501–516
      OpenUrl
    50. ↵
      1. Crocoli A,
      2. Tornesello A,
      3. Pittiruti M, et al
      . Central venous access devices in pediatric malignancies: a position paper of Italian Association of Pediatric Hematology and Oncology. J Vasc Access. 2015;16(2):130–136
      OpenUrl
    51. ↵
      1. Debourdeau P,
      2. Kassab Chahmi D,
      3. Le Gal G, et al; Working Group of the SOR; French National Feberation of Cancer Centers
      . 2008 SOR guidelines for the prevention and treatment of thrombosis associated with central venous catheters in patients with cancer: report from the Working Group. Ann Oncol. 2009;20(9):1459–1471
      OpenUrlCrossRefPubMed
      1. de Carvalho Onofre PS,
      2. da Luz Gonçalves Pedreira M,
      3. Peterlini MAS
      . Placement of peripherally inserted central catheters in children guided by ultrasound: a prospective randomized, and controlled trial. Pediatr Crit Care Med. 2012;13(5):e282–e287
      OpenUrlPubMed
      1. de Souza TH,
      2. Brandão MB,
      3. Santos TM,
      4. Pereira RM,
      5. Nogueira RJN
      . Ultrasound guidance for internal jugular vein cannulation in PICU: a randomised controlled trial. Arch Dis Child. 2018;103(10):952–956
      OpenUrlAbstract/FREE Full Text
    54. ↵
      1. DeWitt AG,
      2. Zampi JD,
      3. Donohue JE,
      4. Yu S,
      5. Lloyd TR
      . Fluoroscopy-guided umbilical venous catheter placement in infants with congenital heart disease. Congenit Heart Dis. 2015;10(4):317–325
      OpenUrl
    55. ↵
      1. Dheer G,
      2. Chaudhry GK,
      3. Singh T
      . Immediate complications of percutaneous central venous cannulation in children. J Indian Assoc Pediatr Surg. 2011;16(4):145–147
      OpenUrlCrossRefPubMed
    56. ↵
      1. Doellman D,
      2. Buckner JK,
      3. Hudson Garrett J Jr.,
      4. Catudal JP,
      5. Frey AM,
      6. Lamagna P
      . Best Practice Guidelines in the Care and Maintenance of Pediatric Central Venous Catheters, 2nd ed. Herriman, UT: Association for Vascular Access; 2015
    57. ↵
      1. Dongara AR,
      2. Patel DV,
      3. Nimbalkar SM,
      4. Potana N,
      5. Nimbalkar AS
      . Umbilical venous catheter versus peripherally inserted central catheter in neonates: a randomized controlled trial. J Trop Pediatr. 2017;63(5):374–379
      OpenUrl
    58. ↵
      1. Elser HE
      . Options for securing umbilical catheters. Adv Neonatal Care. 2013;13(6):426–429
      OpenUrl
    59. ↵
      1. Fallon SC,
      2. Kim ME,
      3. Fernandes CJ,
      4. Vasudevan SA,
      5. Nuchtern JG,
      6. Kim ES
      . Identifying and reducing early complications of surgical central lines in infants and toddlers. J Surg Res. 2014;190(1):246–250
      OpenUrlCrossRefPubMed
    60. ↵
      1. Faustino EV,
      2. Spinella PC,
      3. Li S, et al
      . Incidence and acute complications of asymptomatic central venous catheter-related deep venous thrombosis in critically ill children. J Pediatr. 2013;162(2):387–391
      OpenUrlCrossRefPubMed
      1. Froehlich CD,
      2. Rigby MR,
      3. Rosenberg ES, et al
      . Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit. Crit Care Med. 2009;37(3):1090–1096
      OpenUrlCrossRefPubMed
    62. ↵
      1. Frykholm P,
      2. Pikwer A,
      3. Hammarskjöld F, et al; Swedish Society of Anaesthesiology and Intensive Care Medicine
      . Clinical guidelines on central venous catheterisation. Acta Anaesthesiol Scand. 2014;58(5):508–524
      OpenUrlCrossRefPubMed
    63. ↵
      1. Gaballah M,
      2. Krishnamurthy G,
      3. Keller MS,
      4. McIntosh A,
      5. Munson DA,
      6. Cahill AM
      . US-guided placement and tip position confirmation for lower-extremity central venous access in neonates and infants with comparison versus conventional insertion. J Vasc Interv Radiol. 2014;25(4):548–555
      OpenUrl
      1. Gallagher RA,
      2. Levy J,
      3. Vieira RL,
      4. Monuteaux MC,
      5. Stack AM
      . Ultrasound assistance for central venous catheter placement in a pediatric emergency department improves placement success rates. Acad Emerg Med. 2014;21(9):981–986
      OpenUrlPubMed
    65. ↵
      1. Gonzalez G,
      2. Davidoff AM,
      3. Howard SC, et al
      . Safety of central venous catheter placement at diagnosis of acute lymphoblastic leukemia in children. Pediatr Blood Cancer. 2012;58(4):498–502
      OpenUrlCrossRefPubMed
    66. ↵
      1. Gorski L,
      2. Hadaway L,
      3. Hagle M,
      4. McGoldrick M,
      5. Orr M,
      6. Doellman D
      . Infusion therapy standards of practice. J Infus Nurs. 2016;39:S1–S169
      OpenUrl
    67. ↵
      1. Gray BW,
      2. Gonzalez R,
      3. Warrier KS, et al
      . Characterization of central venous catheter-associated deep venous thrombosis in infants. J Pediatr Surg. 2012;47(6):1159–1166
      OpenUrlPubMed
      1. Gurien LA,
      2. Blakely ML,
      3. Russell RT, et al; Pediatric Surgery Research (PedSRC) Collaborative
      . Real-time ultrasonography for placement of central venous catheters in children: a multi-institutional study. Surgery. 2016;160(6):1605–1611
      OpenUrlPubMed
    69. ↵
      1. Habas F,
      2. Baleine J,
      3. Milési C, et al
      . Supraclavicular catheterization of the brachiocephalic vein: a way to prevent or reduce catheter maintenance-related complications in children. Eur J Pediatr. 2018;177(3):451–459
      OpenUrl
    70. ↵
      1. Hamed RK,
      2. Hartmans S,
      3. Gausche-Hill M
      . Anesthesia through an intraosseous line using an 18-gauge intravenous needle for emergency pediatric surgery. J Clin Anesth. 2013;25(6):447–451
      OpenUrl
    71. ↵
      1. Hancock-Howard R,
      2. Connolly BL,
      3. McMahon M, et al
      . Cost-effectiveness analysis of implantable venous access device insertion using interventional radiologic versus conventional operating room methods in pediatric patients with cancer. J Vasc Interv Radiol. 2010;21(5):677–684
      OpenUrlCrossRefPubMed
    72. ↵
      1. Handrup MM,
      2. Møller JK,
      3. Frydenberg M,
      4. Schrøder H
      . Placing of tunneled central venous catheters prior to induction chemotherapy in children with acute lymphoblastic leukemia. Pediatr Blood Cancer. 2010;55(2):309–313
      OpenUrlCrossRefPubMed
    73. ↵
      1. Hanson SJ,
      2. Punzalan RC,
      3. Christensen MA,
      4. Ghanayem NS,
      5. Kuhn EM,
      6. Havens PL
      . Incidence and risk factors for venous thromboembolism in critically ill children with cardiac disease. Pediatr Cardiol. 2012;33(1):103–108
      OpenUrlPubMed
    74. ↵
      1. Heinrichs J,
      2. Fritze Z,
      3. Klassen T,
      4. Curtis S
      . A systematic review and meta-analysis of new interventions for peripheral intravenous cannulation of children. Pediatr Emerg Care. 2013;29(7):858–866
      OpenUrlCrossRefPubMed
    75. ↵
      1. Institute for Healthcare Improvement
      . How-to Guide: Prevent Central Line-Associated Bloodstream Infection (CLABSI). Cambridge, MA: Institute for Healthcare Improvement; 2012
    76. ↵
      1. Intravenous Nursing New Zealand Incorporated Society
      . Provisional Infusion Therapy Standards of Practice. Auckland, New Zealand: Intravenous Nursing New Zealand Incorporated Society; 2012
    77. ↵
      1. Katsogridakis YL,
      2. Seshadri R,
      3. Sullivan C,
      4. Waltzman ML
      . Veinlite transillumination in the pediatric emergency department: a therapeutic interventional trial. Pediatr Emerg Care. 2008;24(2):83–88
      OpenUrlCrossRefPubMed
    78. ↵
      1. Kim EH,
      2. Lee JH,
      3. Song IK, et al
      . Real-time ultrasound-guided axillary vein cannulation in children: a randomised controlled trial. Anaesthesia. 2017;72(12):1516–1522
      OpenUrl
    79. ↵
      1. Kulkarni S,
      2. Wu O,
      3. Kasthuri R,
      4. Moss JG
      . Centrally inserted external catheters and totally implantable ports for the delivery of chemotherapy: a systematic review and meta-analysis of device-related complications. Cardiovasc Intervent Radiol. 2014;37(4):990–1008
      OpenUrlCrossRefPubMed
    80. ↵
      1. Kulkarni R,
      2. Presley RJ,
      3. Lusher JM, et al
      . Complications of haemophilia in babies (first two years of life): a report from the Centers for Disease Control and Prevention Universal Data Collection System. Haemophilia. 2017;23(2):207–214
      OpenUrlPubMed
    81. ↵
      1. Lam PW,
      2. Volling C,
      3. Chan T, et al
      . Impact of defaulting to single-lumen peripherally inserted central catheters on patient outcomes: an interrupted time series study. Clin Infect Dis. 2018;67(6):954–957
      OpenUrl
    82. ↵
      1. Lamperti M,
      2. Bodenham AR,
      3. Pittiruti M, et al
      . International evidence-based recommendations on ultrasound-guided vascular access. Intensive Care Med. 2012;38(7):1105–1117
      OpenUrlCrossRefPubMed
    83. ↵
      1. Lau CS,
      2. Chamberlain RS
      . Ultrasound-guided central venous catheter placement increases success rates in pediatric patients: a meta-analysis. Pediatr Res. 2016;80(2):178–184
      OpenUrl
    84. ↵
      1. Levy I,
      2. Bendet M,
      3. Samra Z,
      4. Shalit I,
      5. Katz J
      . Infectious complications of peripherally inserted central venous catheters in children. Pediatr Infect Dis J. 2010;29(5):426–429
      OpenUrlCrossRefPubMed
    85. ↵
      1. Lindquester WS,
      2. Hawkins CM,
      3. Monroe EJ, et al
      . Single-stick tunneled central venous access using the jugular veins in infants weighing less than 5 kg. Pediatr Radiol. 2017;47(12):1682–1687
      OpenUrl
    86. ↵
      1. Loveday HP,
      2. Wilson JA,
      3. Pratt RJ, et al; UK Department of Health
      . epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect. 2014;86(suppl 1):S1–S70
      OpenUrlCrossRefPubMed
    87. ↵
      1. Malbezin S,
      2. Gauss T,
      3. Smith I, et al
      . A review of 5434 percutaneous pediatric central venous catheters inserted by anesthesiologists. Paediatr Anaesth. 2013;23(11):974–979
      OpenUrlCrossRefPubMed
    88. ↵
      1. Marshall AM,
      2. Danford DA,
      3. Curzon CL,
      4. Anderson V,
      5. Delaney JW
      . Traditional long-term central venous catheters versus transhepatic venous catheters in infants and young children. Pediatr Crit Care Med. 2017;18(10):944–948
      OpenUrl
    89. ↵
      1. Marquez A,
      2. Shabanova V,
      3. Faustino EV; Northeast Pediatric Critical Care Research Consortium
      . Prediction of catheter-associated thrombosis in critically ill children. Pediatr Crit Care Med. 2016;17(11):e521–e528
      OpenUrl
    90. ↵
      1. May TL,
      2. Gifford AH,
      3. Lahiri T, et al
      . Complications of long and intermediate term venous catheters in cystic fibrosis patients: a multicenter study. J Cyst Fibros. 2018;17(1):96–104
      OpenUrl
    91. ↵
      1. Menéndez JJ,
      2. Verdú C,
      3. Calderón B, et al
      . Incidence and risk factors of superficial and deep vein thrombosis associated with peripherally inserted central catheters in children. J Thromb Haemost. 2016;14(11):2158–2168
      OpenUrlPubMed
    92. ↵
      1. Mermel LA,
      2. Allon M,
      3. Bouza E, et al
      . Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America [published correction appears in Clin Infect Dis. 2010;50(7):1079]. Clin Infect Dis. 2009;49(1):1–45
      OpenUrlCrossRefPubMed
    93. ↵
      1. Moon HM,
      2. Kim S,
      3. Yun KW, et al
      . Clinical characteristics and risk factors of long-term central venous catheter-associated bloodstream infections in children. Pediatr Infect Dis J. 2018;37(5):401–406
      OpenUrl
    94. ↵
      1. Mushtaq A,
      2. Navalkele B,
      3. Kaur M, et al
      . Comparison of complications in midlines versus central venous catheters: are midlines safer than central venous lines? Am J Infect Control. 2018;46(7):788–792
      OpenUrl
    95. ↵
      1. Nifong TP,
      2. McDevitt TJ
      . The effect of catheter to vein ratio on blood flow rates in a simulated model of peripherally inserted central venous catheters. Chest. 2011;140(1):48–53
      OpenUrlCrossRefPubMed
    96. ↵
      1. O’Grady NP,
      2. Alexander M,
      3. Burns LA, et al; Healthcare Infection Control Practices Advisory Committee
      . Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control. 2011;39(4 suppl 1):S1–S34
      OpenUrlCrossRefPubMed
    97. ↵
      1. Ohno K,
      2. Nakaoka T,
      3. Takama Y,
      4. Higashio A,
      5. Santo K,
      6. Yoneda A
      . Implantable central venous access device in infants: long-term results. Pediatr Int. 2016;58(10):1027–1031
      OpenUrl
    98. ↵
      1. Oulego-Erroz I,
      2. Muñoz-Lozón A,
      3. Alonso-Quintela P,
      4. Rodríguez-Nuñez A
      . Comparison of ultrasound guided brachiocephalic and internal jugular vein cannulation in critically ill children. J Crit Care. 2016;35:133–137
      OpenUrl
      1. Oulego-Erroz I,
      2. González-Cortes R,
      3. García-Soler P, et al; RECANVA Collaborative Study
      . Ultrasound-guided or landmark techniques for central venous catheter placement in critically ill children. Intensive Care Med. 2018;44(1):61–72
      OpenUrlPubMed
    100. ↵
      1. Pacilli M,
      2. Bradshaw CJ,
      3. Clarke SA
      . Use of 8-cm 22G-long peripheral cannulas in pediatric patients. J Vasc Access. 2018;19(5):496–500
      OpenUrl
    101. ↵
      1. Paladini A,
      2. Chiaretti A,
      3. Sellasie KW,
      4. Pittiruti M,
      5. Vento G
      . Ultrasound-guided placement of long peripheral cannulas in children over the age of 10 years admitted to the emergency department: a pilot study. BMJ Paediatr Open. 2018;2(1):e000244
      OpenUrl
    102. ↵
      1. Park JM,
      2. Kim MJ,
      3. Yim HW,
      4. Lee WC,
      5. Jeong H,
      6. Kim NJ
      . Utility of near-infrared light devices for pediatric peripheral intravenous cannulation: a systematic review and meta-analysis. Eur J Pediatr. 2016;175(12):1975–1988
      OpenUrl
    103. ↵
      1. Pasteur MC,
      2. Bilton D,
      3. Hill AT; British Thoracic Society Bronchiectasis non-CF Guideline Group
      . British Thoracic Society guideline for non-CF bronchiectasis. Thorax. 2010;65(suppl 1):i1–i58
      OpenUrlAbstract/FREE Full Text
    104. ↵
      1. Peterson KA,
      2. Phillips AL,
      3. Truemper E,
      4. Agrawal S
      . Does the use of an assistive device by nurses impact peripheral intravenous catheter insertion success in children? J Pediatr Nurs. 2012;27(2):134–143
      OpenUrlCrossRefPubMed
    105. ↵
      1. Perin G,
      2. Scarpa MG
      . Defining central venous line position in children: tips for the tip. J Vasc Access. 2015;16(2):77–86
      OpenUrlCrossRefPubMed
    106. ↵
      1. Pinon M,
      2. Bezzio S,
      3. Tovo PA, et al
      . A prospective 7-year survey on central venous catheter-related complications at a single pediatric hospital. Eur J Pediatr. 2009;168(12):1505–1512
      OpenUrlCrossRefPubMed
    107. ↵
      1. Pittiruti M,
      2. Hamilton H,
      3. Biffi R,
      4. MacFie J,
      5. Pertkiewicz M; ESPEN
      . ESPEN Guidelines on Parenteral Nutrition: central venous catheters (access, care, diagnosis and therapy of complications). Clin Nutr. 2009;28(4):365–377
      OpenUrlCrossRefPubMed
    108. ↵
      1. Polkinghorne KR,
      2. Chin GK,
      3. MacGinley RJ, et al
      . KHA-CARI Guideline: vascular access - central venous catheters, arteriovenous fistulae and arteriovenous grafts [published correction appears in Nephrology (Carlton). 2014;19(1):64]. Nephrology (Carlton). 2013;18(11):701–705
      OpenUrlCrossRefPubMed
    109. ↵
      1. Qian SY,
      2. Horn MT,
      3. Barnes R,
      4. Armstrong D
      . The use of 8-cm 22G Seldinger catheters for intravenous access in children with cystic fibrosis. J Vasc Access. 2014;15(5):415–417
      OpenUrl
    110. ↵
      1. Ramer L,
      2. Hunt P,
      3. Ortega E,
      4. Knowlton J,
      5. Briggs R,
      6. Hirokawa S
      . Effect of intravenous (IV) assistive device (VeinViewer) on IV access attempts, procedural time, and patient and nurse satisfaction. J Pediatr Oncol Nurs. 2016;33(4):273–281
      OpenUrlCrossRefPubMed
    111. ↵
      1. Rauth TP,
      2. Scott BP,
      3. Thomason CK,
      4. Bartilson RE,
      5. Hann TM,
      6. Pietsch JB
      . Central venous catheter placement at the time of extracorporeal membrane oxygenation decannulation: is it safe? J Pediatr Surg. 2008;43(1):53–57; discussion 58
      OpenUrlPubMed
    112. ↵
      1. Revel-Vilk S,
      2. Yacobovich J,
      3. Tamary H, et al
      . Risk factors for central venous catheter thrombotic complications in children and adolescents with cancer. Cancer. 2010;116(17):4197–4205
      OpenUrlCrossRefPubMed
    113. ↵
      1. Rey C,
      2. Alvarez F,
      3. De La Rua V, et al
      . Mechanical complications during central venous cannulations in pediatric patients. Intensive Care Med. 2009;35(8):1438–1443
      OpenUrlCrossRefPubMed
      1. Rivera-Tocancipá D,
      2. Díaz-Sánchez E,
      3. Montalvo-Arce CA
      . Ultrasound versus anatomical landmarks: immediate complications in the central venous catheterization in children under 18 years of age. Rev Esp Anestesiol Reanim. 2018;65(7):366–372
      OpenUrl
    115. ↵
      1. Rosado V,
      2. Camargos PA,
      3. Clemente WT,
      4. Romanelli RM
      . Incidence of infectious complications associated with central venous catheters in pediatric population. Am J Infect Control. 2013;41(9):e81–e84
      OpenUrl
    116. ↵
      1. Rossetti F,
      2. Pittiruti M,
      3. Lamperti M,
      4. Graziano U,
      5. Celentano D,
      6. Capozzoli G
      . The intracavitary ECG method for positioning the tip of central venous access devices in pediatric patients: results of an Italian multicenter study. J Vasc Access. 2015;16(2):137–143
      OpenUrl
    117. ↵
      1. Schiffer CA,
      2. Mangu PB,
      3. Wade JC, et al
      . Central venous catheter care for the patient with cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2013;31(10):1357–1370
      OpenUrlAbstract/FREE Full Text
    118. ↵
      1. Sharp R,
      2. Cummings M,
      3. Fielder A,
      4. Mikocka-Walus A,
      5. Grech C,
      6. Esterman A
      . The catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter (PICC): a prospective cohort study. Int J Nurs Stud. 2015;52(3):677–685
      OpenUrl
    119. ↵
      1. Shenep MA,
      2. Tanner MR,
      3. Sun Y, et al
      . Catheter-related complications in children with cancer receiving parenteral nutrition: change in risk is moderated by catheter type. JPEN J Parenter Enteral Nutr. 2017;41(6):1063–1071
      OpenUrl
    120. ↵
      1. Sibson KR,
      2. Biss TT,
      3. Furness CL, et al; British Society for Haematology
      . BSH Guideline: management of thrombotic and haemostatic issues in paediatric malignancy. Br J Haematol. 2018;180(4):511–525
      OpenUrl
    121. ↵
      1. Sigaut S,
      2. Skhiri A,
      3. Stany I, et al
      . Ultrasound guided internal jugular vein access in children and infant: a meta-analysis of published studies. Paediatr Anaesth. 2009;19(12):1199–1206
      OpenUrlCrossRefPubMed
    122. ↵
      1. Smitherman AB,
      2. Alexander T,
      3. Connelly M, et al
      . The incidence of catheter-associated venous thrombosis in noncritically ill children. Hosp Pediatr. 2015;5(2):59–66
      OpenUrlAbstract/FREE Full Text
    123. ↵
      1. Takeshita J,
      2. Nakayama Y,
      3. Nakajima Y, et al
      . Optimal site for ultrasound-guided venous catheterisation in paediatric patients: an observational study to investigate predictors for catheterisation success and a randomised controlled study to determine the most successful site. Crit Care. 2015;19:15–23
      OpenUrl
    124. ↵
      1. The Joint Commission
      . Central line-associated bloodstream infections toolkit and monograph: preventing central line–associated bloodstream infections. With useful tools and an international perspective. 2013. Available at: www.jointcommission.org/CLABSIToolkit. Accessed June, 2018
    125. ↵
      1. Tripi PA,
      2. Thomas S,
      3. Clebone A,
      4. Goldfinger MM,
      5. Tobias JD
      . Peripheral intravenous catheter problems in infants and children presenting for anesthesia and surgery. Middle East J Anaesthesiol. 2016;23(4):411–414
      OpenUrl
      1. Troianos CA,
      2. Hartman GS,
      3. Glas KE, et al; Councils on Intraoperative Echocardiography and Vascular Ultrasound of the American Society of Echocardiography
      . Guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr. 2011;24(12):1291–1318
      OpenUrlCrossRefPubMed
    127. ↵
      1. Unbeck M,
      2. Förberg U,
      3. Ygge BM,
      4. Ehrenberg A,
      5. Petzold M,
      6. Johansson E
      . Peripheral venous catheter related complications are common among paediatric and neonatal patients. Acta Paediatr. 2015;104(6):566–574
      OpenUrl
    128. ↵
      1. van Gent MB,
      2. van der Made WJ,
      3. Marang-van de Mheen PJ,
      4. van der Bogt KE
      . Contemporary insertion of central venous access catheters in pediatric patients: a retrospective record review study of 538 catheters in a single center. Surg Infect (Larchmt). 2017;18(2):105–111
      OpenUrl
      1. Vierboom L,
      2. Darani A,
      3. Langusch C,
      4. Soundappan S,
      5. Karpelowsky J
      . Tunnelled central venous access devices in small children: a comparison of open vs. ultrasound-guided percutaneous insertion in children weighing ten kilograms or less. J Pediatr Surg. 2018;53(9):1832–1838
      OpenUrl
    130. ↵
      1. Vinograd AM,
      2. Zorc JJ,
      3. Dean AJ,
      4. Abbadessa MKF,
      5. Chen AE
      . First-attempt success, longevity, and complication rates of ultrasound-guided peripheral intravenous catheters in children. Pediatr Emerg Care. 2018;34(6):376–380
      OpenUrl
    131. ↵
      1. Voigt J,
      2. Waltzman M,
      3. Lottenberg L
      . Intraosseous vascular access for in-hospital emergency use: a systematic clinical review of the literature and analysis. Pediatr Emerg Care. 2012;28(2):185–199
      OpenUrlPubMed
    132. ↵
      1. Wiegering V,
      2. Schmid S,
      3. Andres O, et al
      . Thrombosis as a complication of central venous access in pediatric patients with malignancies: a 5-year single-center experience. BMC Hematol. 2014;14(1):18
      OpenUrlCrossRefPubMed
    133. ↵
      1. White AD,
      2. Othman D,
      3. Dawrant MJ,
      4. Sohrabi S,
      5. Young AL,
      6. Squire R
      . Implantable versus cuffed external central venous catheters for the management of children and adolescents with acute lymphoblastic leukaemia. Pediatr Surg Int. 2012;28(12):1195–1199
      OpenUrlCrossRefPubMed
    134. ↵
      1. Wragg RC,
      2. Blundell S,
      3. Bader M, et al
      . Patency of neck veins following ultrasound-guided percutaneous Hickman line insertion. Pediatr Surg Int. 2014;30(3):301–304
      OpenUrl
    135. ↵
      1. Wu SY,
      2. Ling Q,
      3. Cao LH,
      4. Wang J,
      5. Xu MX,
      6. Zeng WA
      . Real-time two-dimensional ultrasound guidance for central venous cannulation: a meta-analysis. Anesthesiology. 2013;118(2):361–375
      OpenUrlCrossRefPubMed
    136. ↵
      1. Wyckoff MM,
      2. Sharpe EL
      . Peripherally Inserted Central Catheters: Guideline for Practice, 3rd ed. Chicago, IL: National Association of Neonatal Nurses; 2015
    137. ↵
      1. Xia Y,
      2. Wu Y,
      3. Zhang W, et al
      . Application of peripherally inserted central catheter via femoral vein for pediatric burns. Int J Clin Exp Med. 2016;9:20105–20108
      OpenUrl
    138. ↵
      1. Yacobovich J,
      2. Ben-Ami T,
      3. Abdalla T, et al
      . Patient and central venous catheter related risk factors for blood stream infections in children receiving chemotherapy. Pediatr Blood Cancer. 2015;62(3):471–476
      OpenUrlCrossRefPubMed
      1. Zanolla GR,
      2. Baldisserotto M,
      3. Piva J
      . How useful is ultrasound guidance for internal jugular venous access in children? J Pediatr Surg. 2018;53(4):789–793
      OpenUrlPubMed
    140. ↵
      1. Zengin Y,
      2. Içer M,
      3. Gündüz E,
      4. Dursun R,
      5. Durgun HM,
      6. Güloǧlu C
      . Assessment of central venous catheters applied in pediatric patients at emergency department. J Exp Clin Med (Turkey). 2013;30:345–348
      OpenUrl
    141. ↵
      1. Zhou L,
      2. Xu H,
      3. Liang J,
      4. Xu M,
      5. Yu J
      . Effectiveness of intracavitary electrocardiogram guidance in peripherally inserted central catheter tip placement in neonates. J Perinat Neonatal Nurs. 2017;31(4):326–331
      OpenUrl
    142. ↵
      1. Oestreich AE
      . Umbilical vein catheterization--appropriate and inappropriate placement. Pediatr Radiol. 2010;40(12):1941–1949
      OpenUrlCrossRefPubMed
    143. ↵
      1. DeVries M,
      2. Lee J,
      3. Hoffman L
      . Infection free midline catheter implementation at a community hospital (2 years). Am J Infect Control. 2019;47(9):1118–1121
      OpenUrl
    144. ↵
      1. Kleidon TM,
      2. Cattanach P,
      3. Mihala G,
      4. Ullman AJ
      . Implementation of a paediatric peripheral intravenous catheter care bundle: a quality improvement initiative. J Paediatr Child Health. 2019;55(10):1214–1223
      OpenUrl
    Back to top

    In this issue

    Pediatrics
    Vol. 145, Issue Supplement 3
    1 Jun 2020
    View this article with LENS
    Email Article
    Request Permissions
    Article Alerts
    Citation Tools
    Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review
    Rebecca S. Paterson, Vineet Chopra, Erin Brown, Tricia M. Kleidon, Marie Cooke, Claire M. Rickard, Steven J. Bernstein, Amanda J. Ullman
    Pediatrics Jun 2020, 145 (Supplement 3) S243-S268; DOI: 10.1542/peds.2019-3474H
    del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
    Print
    Download PDF
    Insight Alerts

    Jump to section