Direct Right Atrial Catheterization in Pediatric Short Bowel Syndrome: A Durable and Technically Advantageous Solution for End-stage Vascular Access

Aim: Children with short bowel syndrome (SBS) frequently require long-term total parenteral nutrition (TPN), which increases the risk of progressive central vein thrombosis. Once conventional venous access is exhausted, direct right atrial catheterization becomes a necessary salvage technique. In addition to bypassing thrombosed veins, it allows for the placement of larger-caliber catheters than percutaneous approaches. Materials and Methods: This retrospective study included 17 pediatric SBS patients with end-stage vascular access who underwent direct right atrial catheterization via right anterior thoracotomy. Patient characteristics, vein thrombosis patterns, catheter duration, complications, and reinterventions were analyzed. Results: All patients (100%) had thrombosed jugular veins. Subclavian, hepatic, and femoral vein thrombosis was observed in 41.1%, 29.4%, and 23.6% of the patients, respectively. The median catheter duration was 14.8 months. Four patients (23.6%) developed catheter-related bloodstream infections, including one Candida parapsilosis infection which required complete catheter and port removal with reinsertion. One mechanical complication (5.9%) occurred due to port chamber torsion. Two patients (11.8%) required surgical reintervention. No cases of catheter-related sepsis, tamponade, or mortality were recorded. Larger-bore catheters were successfully implanted in all patients due to the direct atrial route. Conclusion: Direct right atrial catheterization is a safe, durable, and technically advantageous vascular access option in children with SBS and depleted venous anatomy. Its capacity to accommodate large-caliber catheters supports high-volume TPN delivery. This technique should be considered early in the multidisciplinary management of complex intestinal failure.