Thoracoscopic-assisted central line placement for a thrombosed superior vena cava.

BACKGROUND

In children who require prolonged and multiple venous catheterizations, the superior vena cava and iliofemoral veins may become occluded, making central venous access a difficult challenge. We report an innovative technique of catheter insertion percutaneously from the neck into the right atrium traversing a thrombosed superior vena cava using video-assisted thoracoscopic surgery.

METHODS

Two children with irreversible intestinal failure had 4 central venous accesses insertions using the above-mentioned technique. Both had occluded major central veins after multiple catheterizations. An interventional radiologist and cardiologist failed to establish a central venous access in both patients.

RESULTS

A 9-year-old boy has a long-term catheter functioning for 8 months, and in an 18-month-old girl, the line was removed accidentally 6 weeks from its insertion and 2 months later for a line leak. It was then reinserted each time using the same technique.

CONCLUSION

This technique of catheter placement into the right atrium using video-assisted thoracoscopic surgery when other conduits are unavailable can be lifesaving in children depending on total parenteral nutrition.