TY - CHAP M1 - Book, Section TI - Vascular Access Procedures A1 - Zeller, Kristen A. A1 - Petty, John K. A2 - Ziegler, Moritz M. A2 - Azizkhan, Richard G. A2 - Allmen, Daniel von A2 - Weber, Thomas R. PY - 2014 T2 - Operative Pediatric Surgery, 2e AB - Prevention of central line associated bloodstream infections (CLABSI) begins with prevention of the need for central lines. Excellence with placement of peripheral intravenous lines is foundational to prevention of such infections.The intraosseous (IO) route provides rapid vascular access in a crisis. This route may be used effectively in older patients (adolescents and young adults) and in different locations (femur, humerus, radius, both malleoli, and even sternum) than had been traditionally thought to be ideal for this approach.Although the pediatric surgeon commonly performs central venous catheterization, an understanding of the spectrum of approaches and anatomic options will help with the most difficult cases of vascular access.When placing a central venous catheter (CVC), the use of central line insertion checklists and bundles can minimize the risk of CLABSI.Children with long-term indwelling catheters who develop CLABSI present a challenging problem. A systematic approach to this problem will prioritize the health of the child and still preserve vascular access sites.Whether using the guidance of anatomic landmarks or ultrasound imaging, meticulous technique and knowledge of anatomy are imperative for achieving safe central venous access. Ultrasound guidance can be particularly helpful with catheterization of the internal jugular vein. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/10/04 UR - accesspediatrics.mhmedical.com/content.aspx?aid=1100431455 ER -