One universal challenge, particularly in children, is preserving central venous access in patients requiring long-term total parenteral nutrition (TPN). Central vein thrombosis is a common complication of conventional approaches to the superior vena cava through the subclavian and jugular veins.1 Multiple line placements and prolonged administration of TPN in these smaller central veins can result in partial or total occlusion.1'2 Nonconventional approaches to line placement are subsequently attempted, such as percutaneous inferior vena cava placement through a translumbar or transhepatic route,3 retroperitoneal dissection of the hypogastric vein and azygos vein placement through extrapleural minithoracotomy,4 and direct right atrial catheteriza-tion.5 Each technique has advantages and disadvantages, but unfortunately, none of these were a safe or suitable option for this particular patient.
展开▼
