Prompt

You have 9 minutes with a 3-year-old in septic shock who needs central access for an adrenaline infusion and is thrombocytopenic. Choose and justify the site, talk through the ultrasound-guided Seldinger technique, confirm the tip, and describe how you would manage an arterial puncture during the attempt.

Station brief (candidate)

Choose and justify the central venous site for this thrombocytopenic child in septic shock, and state which site you would avoid and why.
Talk through the ultrasound-guided Seldinger technique at your chosen site, naming each step.
Describe how you would confirm correct catheter tip position, and how you would manage an arterial puncture during the attempt.
Outline your central line-associated bloodstream infection prevention bundle. [1] [8]

Paediatrics Fellowship Pro

You have read the opening of this case. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References5Show ledger

[1]Lamperti M International evidence-based recommendations on ultrasound-guided vascular access. Intensive Care Med, 2012.PMID 22614241
[3]Brass P Ultrasound guidance versus anatomical landmarks for subclavian or femoral vein catheterization. Cochrane Database Syst Rev, 2015.PMID 25575245
[8]Duesing LA Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies. Nutr Clin Pract, 2016.PMID 27032770
[11]Zito Marinosci G ECHOTIP-Ped: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in pediatric patients. J Vasc Access, 2023.PMID 34256613
[12]Buetti N Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol, 2022.PMID 35437133

Station brief (candidate)

Choose and justify the central venous site for this thrombocytopenic child in septic shock, and state which site you would avoid and why.

Talk through the ultrasound-guided Seldinger technique at your chosen site, naming each step.

Describe how you would confirm correct catheter tip position, and how you would manage an arterial puncture during the attempt.

Outline your central line-associated bloodstream infection prevention bundle. [1] [8]

Paediatrics Fellowship Pro

You have read the opening of this case. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References5Show ledger

[1]Lamperti M International evidence-based recommendations on ultrasound-guided vascular access. Intensive Care Med, 2012.PMID 22614241
[3]Brass P Ultrasound guidance versus anatomical landmarks for subclavian or femoral vein catheterization. Cochrane Database Syst Rev, 2015.PMID 25575245
[8]Duesing LA Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies. Nutr Clin Pract, 2016.PMID 27032770
[11]Zito Marinosci G ECHOTIP-Ped: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in pediatric patients. J Vasc Access, 2023.PMID 34256613
[12]Buetti N Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol, 2022.PMID 35437133

Central venous and arterial access in children — OSCE

Station brief (candidate)

Central venous and arterial access in children — OSCE

Station brief (candidate)