Transhepatic and Translumbar Approaches for Central Venous Access in Pediatric Patients.

OBJECTIVE

This study evaluated the safety and efficacy of transhepatic and translumbar approaches as alternative routes for central venous access in pediatric patients.

METHODS

Medical records and institutional Picture Archiving and Communication System were reviewed. This study included patients aged <18 years between October 2020 and November 2023. Patients with insufficient medical record information or those who were discharged before the transhepatic catheter removal were excluded.

RESULTS

Eight pediatric patients (4 females and 4 males) with a median age of 3.5 years (range: 0.5-8.0 years) and a median weight of 11.6 kg (range: 2.9-20.85 kg) were treated in the intensive care unit for chronic critical illnesses. The indications for catheter insertion included total parenteral nutrition (62.5%, n=5), hemodialysis (25%, n=2), and long-term medication / central access (12.5%, n=1). The overall complication rate was 62.5% (5/8 patients), primarily consisting of late-onset infections and mechanical dislodgments. The median procedure time was 42 minutes (range: 6-96 minutes), with a median radiation dose (Dose Area Product) of 9 mGy.cm2 (range: 3.6-36 mGy.cm2). All patients were monitored in the intensive care unit for at least 24 hours post-intervention. The median catheter patency was 132 days (range: 0-420 days) for primary procedures and 126.5 days (range: 0-261 days) for secondary procedures. Overall technical success in achieving central venous access was 100% (8/8 patients). While 1 patient (P.7) experienced initial transhepatic failures, successful vascular access was ultimately established through a translumbar rescue procedure. Overall mortality was 25% (2/8 patients); 1 patient died 261 days after the second procedure and another 7 days post-intervention, both due to underlying comorbidities unrelated to the procedures.

CONCLUSION

The transhepatic and translumbar approaches offer alternative access when traditional routes are unavailable; however, their shorter patency durations highlight the need for specialized catheters designed for these techniques.