Central Venous Access in Children with Intestinal Failure

Patient Guideline Summary

Publication Date: February 28, 2021
Last Updated: March 2, 2023

Objective

Objective

This patient summary means to discuss key recommendations from the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition for central venous access in children with intestinal failure.

Overview

Overview

  • Intestinal failure occurs when the digestive system cannot nourish the body.
    • As a result, patients with intestinal failure must be nourished parenterally (directly into the blood circulation).
    • Access must be through large (central) veins that are capable of handling the nutritional liquids.
  • The major complications to avoid are infection and blood clotting in the access vein.
  • The most common causes of intestinal failure are intestinal disease or trauma that requires surgical removal of large amounts of the bowel.
  • Symptoms are the result of malnutrition.
  • This patient summary focuses on maintaining intravenous access in children requiring parenteral nutrition because of intestinal failure.

Treatment

Treatment

  • Preferred veins are in the arms.
  • Expertise is required for establishing and maintaining access, ideally within or with consultation from centers that also perform intestinal transplants.
  • All caregivers, both in hospital and at home, must be thoroughly acquainted with proper procedures for managing access.
  • Blood clots and infections should be treated immediately in the hospital.
  • Routine surveillance is accomplished with ultrasound imaging.

Additional Considerations
  • Supplies and instructions for emergencies must be available.
  • A fever requires hospitalization.
  • Activities must be planned to protect the access devices.
    • Travel, swimming, and other sports require special preparations.
  • The ultimate treatment for intestinal failure is intestinal transplantation.

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.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.