Pediatric central line

Size

Age (yrs) Internal Jugular Subclavian Femoral
0-0.5 3F 3F 3F
0.5-2 3F 3F 3-4F
3-6 4F 4F 4-5F
7-12 4-5F 4-5F 5-8F

Insertion Distance

Initial length of insertion (cm) = 1.7 + [(0.07 x height (cm)][1]

Contraindications

Absolute[2]

  • Infection over the placement site
  • Anatomic obstruction (thrombosis of target vein, other anatomic variance)
  • Site-specific
    • Subclavian - trauma/fracture to ipsilateral clavicle or proximal ribs

Relative

  • Coagulopathy (see below)
  • Distortion of landmarks by trauma or congenital anomalies
  • Prior vessel injury or procedures
  • Morbid obesity
  • Uncooperative/combative patient

Central line if coagulopathic

  • Preferentially use a compressible site such as the femoral location (avoid the IJ and subclavian if possible)
  • No benefit to giving FFP unless artery is punctured[3]

See Also

Vascular access types

References

  1. http://110.164.68.227/homelibrary/rj_online/Acta_anes/2006/Vol.50/No.3March/Depth355.pdf Yoon, S. et al Depth of a central venous catheter tip: length of insertion guideline for pediatric patients. Acta Anaesthesiol Scand 2006; 50: 355—357
  2. Graham, A.S., et al. Central Venous Catheterization. N Engl J Med 2007;356:e21
  3. Fisher NC, Mutimer DJ. Central venous cannulation in patients with liver disease and coagulopathy—a prospective audit. Intens Care Med 1999; 25:5
  4. Morado M.et al. Complications of central venous catheters in patients with haemophilia and inhibitors. Haemophilia 2001; 7:551–556