Percutaneous insertion of central venous feeding catheters.

Since 1968 when Wilmore and Dudrick described normal growth and development in a child receiving all nutrients intravenously,' the practice of total parenteral nutrition in infants and children has become established as a life saving procedure.2 Maintaining the infusion of hypertonic feeding solutions by the use of peripheral veins over anything but short periods is unpleasant for the patients and becomes increasingly technically difficult, especially in small babies. An alternative approach that employs central venous catheterisation is convenient for the patient but depends upon the availability of skilled surgeons and theatre facilities. In addition, it carries with it certain risks, particularly serious infection. In 1973 Shaw described a simple way of inserting central feeding lines percutaneously when administering total parenteral nutrition to sick low birthweight babies on special care baby units,3 where it has since become an established practice.4 The same technique has also been advocated for use in older children.5 We have found this method well suited to small babies under 1 year of age recovering from gastrointestinal surgery or with other indications for total parenteral nutrition. In our hospital all patients receiving total parenteral nutrition are initially referred to a nutritional care team for assessment and daily supervision of fluid and nutritional requirements. In addition, one member of this team (JP) has inserted a central venous feeding line if requested, using the technique described by Shaw.3 The patient is thereby spared a surgical procedure and anaesthetic, while pressure of work on busy surgical colleagues and theatre staff is reduced. The whole process is less labour intensive than surgical insertion and therefore considerably cheaper.