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首页> 外文期刊>Current opinion in anaesthesiology >Central venous catheter techniques in infants and children
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Central venous catheter techniques in infants and children

机译：婴幼儿中心静脉导管技术

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The placement of central venous catheters is often necessary to facilitate optimal anaesthetic and perioperative management or for the long-term management of chronic underlying diseases. Insertion may be a challenge in selected patients, and the risk of infection, thrombosis, and other complications may result in significant risk factors.Ultrasound visualization of the cervical veins with Valsalva manoeuvres significantly increases the rate and safety of central venous cannulation, and decreases needle passes in paediatric patients even with experienced operators. Pericardial effusion with tamponade is a more frequent phenomenon than generally realized, and accurate location of the catheter-tip position is essential. The femoral venous approach has proved to be safe even in premature babies. Clear guidelines for infection control and the prevention of intravascular catheter-related infections in children have been established; however, the high incidence of nosocomial catheter-related infections requires effective prevention strategies. The impact of antimicrobial-impregnated central venous catheters on the prevention of bloodstream infections in children is not yet clear. Routine use of prophylactic antibiosis (i.e. vancomycin) to prevent catheter-related infection cannot be recommended. Thrombolytic therapy with recombinant tissue plasminogen activator is safe, efficient, well tolerated and effective for lysis of catheter-induced intravascular and intracardiac thrombi even in neonates. Embolized catheter fragments can be retrieved in neonates and children by non-surgical interventions using standard procedures applied by paediatric cardiologists.Despite a variety of new techniques, the major problem of central venous catheterization in neonates and children remains the prevention of catheter-related infection and infection control.
机译：通常需要放置中央静脉导管，以促进最佳的麻醉和围手术期管理或对慢性潜在疾病的长期管理。插入可能是某些患者的一个挑战，并且感染，血栓形成和其他并发症的风险可能会导致重大的危险因素。通过Valsalva动作对颈静脉进行超声检查显着提高了中心静脉插管的速度和安全性，并减少了穿刺针的数量即使有经验的操作员，也能使儿科患者通过。心包积液与填塞物相比通常要更常见，并且导管尖端位置的准确定位至关重要。事实证明，即使在早产儿中，股静脉手术也是安全的。已经建立了明确的儿童感染控制和预防血管内导管相关感染的指南;然而，医院导管相关感染的高发需要有效的预防策略。尚不清楚用抗菌药物浸渍的中心静脉导管对预防儿童血液感染的影响。建议不要常规使用预防性抗生素（万古霉素）预防与导管相关的感染。重组重组纤溶酶原激活剂的溶栓治疗即使在新生儿中也安全，有效，耐受性良好，对导管诱发的血管内和心脏内血栓的溶解是有效的。可以通过儿科心脏病专家采用标准程序通过非手术干预在新生儿和儿童中回收栓塞的导管碎片。尽管有多种新技术，但新生儿和儿童中中心静脉导管的主要问题仍然是如何预防与导管相关的感染和感染控制。

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