Management of Central Venous Access in Children With Intestinal Failure

Publication Date: February 28, 2021
Last Updated: March 14, 2022

Recommendations

Types of central venous access

1. Tunneled, single lumen, cuffed silicone catheters should be used for children with intestinal failure.
2. Upper extremity access is the preferred location when available.
3. Alternative line sites and endovascular procedures should only be done by experienced interventionalists in discussion with an intestinal transplant center when transplant evaluation has been or will be sought.
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Routine care of central venous catheter

1. Proper technique and hygiene surrounding central venous catheter care are of paramount importance in preventing central venous catheter-associated complications. Caregivers should receive directed education regarding central venous catheter cares before initial discharge, with subsequent reinforcement education as needed.
2. Chlorhexidine gluconate impregnated supplies (disk, sponge, or dressing) should be considered for central line dressing in pediatric intestinal failure patients.
3. Routine surveillance of central venous access should be performed by ultrasonography. MR, CT, or traditional venography should be reserved for assessment for when further delineation of access is required.
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Additional considerations for care

1. All children with intestinal failure should be provided with an emergency letter that details specific needs of the individual child in case of an emergency.
2. Discuss with families the risks of swimming and sports participation with strategies to protect the dressing and central line.
3. All travel plans should be discussed with the intestinal rehabilitation team well in advance of travel to facilitate discussion of a plan of care in case of emergency.
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Central line-associated bloodstream infections

1. All children with intestinal failure and central venous catheter who develop a fever (38.0° C) should be admitted to the hospital and assessed for bacteremia with central and peripheral blood cultures while receiving broad-spectrum empiric antibiotics through the central venous catheter for at least 48 h, awaiting culture results regardless of other infectious sources.
2. If clinically stable, discuss with the patient’s intestinal rehabilitation program before line removal for central line-associated bloodstream infection.
3. Prophylactic lock therapy with ethanol or other nonantibiotic locks should be strongly considered in all children with intestinal failure who have had at least one central line-associated bloodstream infection or are at high risk for infection.
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Mechanical complications

1. In children with intestinal failure, central venous catheters should be repaired whenever possible to preserve central venous access.
2. Children with intestinal failure and a newly identified catheter-related thrombus should be treated with low molecular weight heparin for at least 6 weeks with guidance from a hematologist.
3. Children with intestinal failure who have persistence of at least one chronic thrombus should be maintained on prophylactic anticoagulation with low molecular weight heparin.
4.Children who have lost multiple sites of central venous access should be considered for referral to an intestinal transplant center for evaluation and management.
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Central venous access program management

1. All centers following children with intestinal failure should track the number of outpatient central line-associated bloodstream infections per 1000 catheter days.
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Recommendation Grading

Overview

Title

Management of Central Venous Access in Children With Intestinal Failure

Authoring Organization

North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

Publication Month/Year

February 28, 2021

Last Updated Month/Year

April 1, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Child

Health Care Settings

Ambulatory, Childcare center, Hospital, Long term care

Intended Users

Dietician nutritionist, nurse, nurse practitioner, physician, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D010288 - Parenteral Nutrition, D062905 - Central Venous Catheters

Keywords

parenteral nutrition, Central Venous Catheter, Catheter-related thrombosis, central line-associated bloodstream infection, intestinal rehabilitation program

Source Citation

Wendel D, Mezoff EA, Raghu VK, Kinberg S, Soden J, Avitzur Y, Rudolph JA, Gniadek M, Cohran VC, Venick RS, Cole CR. Management of Central Venous Access in Children With Intestinal Failure: A Position Paper From the NASPGHAN Intestinal Rehabilitation Special Interest Group. J Pediatr Gastroenterol Nutr. 2021 Mar 1;72(3):474-486. doi: 10.1097/MPG.0000000000003036. PMID: 33399327; PMCID: PMC8260029.

Supplemental Methodology Resources

Data Supplement