Lines, tubes, and the pediatrician

October 1, 2010

There was a time, not so very long ago, when a child who needed to receive nourishment or medications through a vein had to be in the hospital.

Hospitals that provide up-to-date pediatric care employ nurses who are specially trained to place peripherally inserted central catheters (PICC lines) in even the smallest of premature infants, and nurses and technicians (stoma therapists) are trained specifically to deal with the skin irritation that sometimes complicates the care of children with enteral tubes. Pediatric surgeons place central catheters that are designed and inserted using techniques to resist infection, although infection remains an important cause of morbidity for children with central lines of all types.

All of this progress has happened within the walls of hospitals, operating rooms, and clinics whose staff members are trained to place and maintain the lines and tubes. But what about the care and maintenance of these appliances once the child has been discharged? What is the role of the pediatrician-the captain of the medical home-when the health of the patient is maintained through technology with which he or she is unfamiliar?

Lukish raises a concern that has become central to the care of all children with special healthcare needs: communication. Even the most sophisticated electronic health record system may not supply the primary care provider with details about catheter and tube size, frequency or type of flush, dose of medication, and plans for device removal, although the pediatrician may be asked about all of these aspects of their patients' care by parents and home care companies requesting approval for renewal of orders.

The technologic pieces may be available to provide sophisticated care for children at home; however, if pediatricians are going to coordinate the care of those children, it's important to be knowledgeable about tubes and lines. Lukish's article is a good place to start.

DR MCMILLAN Editor-in-Chief Contemporary Pediatrics