Line tunnellers provided in prepacked paediatric central venous catheter kits are often significantly larger than the small line being placed. This risks unnecessary tissue trauma and increases the chance of early line slippage. Our department often inserts medium-term access in patients as young as two months old. One solution is to substitute the tunneller for a malleable 178mm probe (SC-G1/290; Surgical Holdings, Southend-on-Sea, UK) with an eye, through which the line is threaded. We have found it to be readily available, a better match for the extremely small paediatric lines we insert and easily shaped to a curve for tunnelling (Fig 1).
Figure 1.
The standard 9.6Fr tunneller provided (A), the probe used at our centre (B) and a 3.3Fr paediatric tunnelled line (C)
Acknowledgement
The authors acknowledge the role of S Donnell, consultant paediatric surgeon, and Professor PD Losty, professor of paediatric surgery in the instruction of this technique.
References
- 1.Arul GS, Lewis N, Bromley P et al. Ultrasound-guided percutaneous insertion of Hickman lines in children. Prospective study of 500 consecutive procedures. J Pediatr Surg 2009; : 1,371–1,376. [DOI] [PubMed] [Google Scholar]
- 2.Hanson JM, Challiss D, Primrose JN, Plusa SM. Blind percutaneous insertion of Hickman lines by a specialist team. Ann R Coll Surg Engl 2001; : 332–334. [PMC free article] [PubMed] [Google Scholar]