Introduction

Vascular access remains an essential aspect of the surgical care of children. These procedures – including peripheral venous, central venous and peripheral arterial access – make up a core component of a pediatric surgeon’s practice in both the perioperative and intensive care settings. The pediatric patient presents a particular challenge for vascular access as the vascular targets are often exceedingly small and fragile. Additional challenges are present in the chronically ill child where multiple prior access procedures lead to the exhaustion of viable targets. This is especially true for central venous access which is critical for the supportive care of these children. The advent of safe and reliable techniques and technologies for central venous access has changed the face of pediatric surgery. By enabling the long term delivery of total parenteral nutrition, for example, previously terminal diseases such as short bowel syndrome have become survivable problems.

This module will review the major concepts of vascular access. This will include the methods of obtaining vascular access such as ultrasound (US) guided, cut down and landmark based techniques. This module will also discuss difficult or advanced peripheral access scenarios such as difficult peripherally inserted central catheters, arterial access and venous access using US and cut down. Other topics will include wire and catheter selection, venography, fluoroscopy and how to approach the patient with thrombosis of the great vessels.

see also Vascular Access Procedures and the New Technology Committee page for their toolkit using ultrasound in pediatic surgery