Combined surgical and interventional cardiology approach for central venous access salvage in children with intestinal failure: A case series
Background: Pediatric patients with intestinal failure are critically dependent on central venous access for nutrition and fluids. Long-term central venous access can be complicated by recurrent infections, catheter malfunction, and venous stricture and thrombosis. Prior studies have discussed hybri...
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Elsevier
2025-01-01
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| Series: | Journal of Pediatric Surgery Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2949711624000716 |
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| author | Emily Byrd M. Jake Petersen Minna M. Wieck Frank Ing Shinjiro Hirose |
| author_facet | Emily Byrd M. Jake Petersen Minna M. Wieck Frank Ing Shinjiro Hirose |
| author_sort | Emily Byrd |
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| description | Background: Pediatric patients with intestinal failure are critically dependent on central venous access for nutrition and fluids. Long-term central venous access can be complicated by recurrent infections, catheter malfunction, and venous stricture and thrombosis. Prior studies have discussed hybrid procedures to salvage suboptimal central venous access sites; however, data is very limited. Methods: This is a retrospective review of six pediatric patients with intestinal failure (IF) and long-term total parenteral nutrition (TPN) dependence who underwent one or more hybrid procedures for achieving complex vascular access, vascular mapping, and/or salvage of vascular access sites. Results: Median age at the time of intervention was 1.4 years (range 2.5 weeks – 2.6 years) with a median weight of 10 kg (range 3.3–13.8 kg). The median number of lifetime central lines was 4 (range 2–6). Indications for hybrid intervention included line fractures, occlusions, dislodgement, recurrent infections, and refractory central line infection. The most common procedures included vascular access, vein mapping, and balloon angioplasty of occluded central veins. The median procedure time was 4.6 h (range 1.3–5.9 h) with a median procedural radiation dose of 2.2 Gycm2 (range 0.1–6.7 Gycm2). All patients who underwent hybrid procedures had successful exchange and/or rehabilitation of the at-risk access site. Conclusions: These cases highlight the importance of vascular mapping for identifying potential access sites, as well as techniques for successful vascular rehabilitation for maintenance or salvage of existing central venous access. A multidisciplinary hybrid approach is a feasible and effective means of maintaining central venous access. |
| format | Article |
| id | doaj-art-f03db5190e5a4636924963aa125d5900 |
| institution | Kabale University |
| issn | 2949-7116 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Pediatric Surgery Open |
| spelling | doaj-art-f03db5190e5a4636924963aa125d59002025-01-22T05:44:36ZengElsevierJournal of Pediatric Surgery Open2949-71162025-01-019100186Combined surgical and interventional cardiology approach for central venous access salvage in children with intestinal failure: A case seriesEmily Byrd0M. Jake Petersen1Minna M. Wieck2Frank Ing3Shinjiro Hirose4Department of Surgery, Division of Pediatric General, Thoracic, and Fetal Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA, 95817, USADepartment of Pediatrics, Division of Pediatric Cardiology, University of California Davis Medical Center, 2521 Stockton Blvd., Sacramento, CA, 95817, USADepartment of Surgery, Division of Pediatric General, Thoracic, and Fetal Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA, 95817, USADepartment of Pediatrics, Division of Pediatric Cardiology, University of California Davis Medical Center, 2521 Stockton Blvd., Sacramento, CA, 95817, USADepartment of Surgery, Division of Pediatric General, Thoracic, and Fetal Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA, 95817, USA; Corresponding author at: 2335 Stockton Blvd, North Addition Office Building 5th Floor, Sacramento, CA, 95817, USA.Background: Pediatric patients with intestinal failure are critically dependent on central venous access for nutrition and fluids. Long-term central venous access can be complicated by recurrent infections, catheter malfunction, and venous stricture and thrombosis. Prior studies have discussed hybrid procedures to salvage suboptimal central venous access sites; however, data is very limited. Methods: This is a retrospective review of six pediatric patients with intestinal failure (IF) and long-term total parenteral nutrition (TPN) dependence who underwent one or more hybrid procedures for achieving complex vascular access, vascular mapping, and/or salvage of vascular access sites. Results: Median age at the time of intervention was 1.4 years (range 2.5 weeks – 2.6 years) with a median weight of 10 kg (range 3.3–13.8 kg). The median number of lifetime central lines was 4 (range 2–6). Indications for hybrid intervention included line fractures, occlusions, dislodgement, recurrent infections, and refractory central line infection. The most common procedures included vascular access, vein mapping, and balloon angioplasty of occluded central veins. The median procedure time was 4.6 h (range 1.3–5.9 h) with a median procedural radiation dose of 2.2 Gycm2 (range 0.1–6.7 Gycm2). All patients who underwent hybrid procedures had successful exchange and/or rehabilitation of the at-risk access site. Conclusions: These cases highlight the importance of vascular mapping for identifying potential access sites, as well as techniques for successful vascular rehabilitation for maintenance or salvage of existing central venous access. A multidisciplinary hybrid approach is a feasible and effective means of maintaining central venous access.http://www.sciencedirect.com/science/article/pii/S2949711624000716Central line accessHybrid interventions |
| spellingShingle | Emily Byrd M. Jake Petersen Minna M. Wieck Frank Ing Shinjiro Hirose Combined surgical and interventional cardiology approach for central venous access salvage in children with intestinal failure: A case series Journal of Pediatric Surgery Open Central line access Hybrid interventions |
| title | Combined surgical and interventional cardiology approach for central venous access salvage in children with intestinal failure: A case series |
| title_full | Combined surgical and interventional cardiology approach for central venous access salvage in children with intestinal failure: A case series |
| title_fullStr | Combined surgical and interventional cardiology approach for central venous access salvage in children with intestinal failure: A case series |
| title_full_unstemmed | Combined surgical and interventional cardiology approach for central venous access salvage in children with intestinal failure: A case series |
| title_short | Combined surgical and interventional cardiology approach for central venous access salvage in children with intestinal failure: A case series |
| title_sort | combined surgical and interventional cardiology approach for central venous access salvage in children with intestinal failure a case series |
| topic | Central line access Hybrid interventions |
| url | http://www.sciencedirect.com/science/article/pii/S2949711624000716 |
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