Evaluating the Factors Influencing Pediatric Central Venous Catheterization: A Retrospective Study on Complications and Success Rates
DOI:
https://doi.org/10.63682/jns.v14i16S.4508Keywords:
Central venous catheters, Ultrasound-guidance, Pneumothorax, central line-associated bloodstream infections (CLABIs), Arterial puncturesAbstract
Background: Complications correlated with central venous catheterization (CVC) are common and risky in pediatric patients leading to increased morbidity.
Objective: To study the CVC-related complications concerning different access sites and ultrasound (US)-guided catheterization.
Methods: This retrospective study was conducted in a tertiary care teaching institution in central India. Children admitted to pediatric and pediatric surgical intensive care units between 2014 and 2018 requiring CVCs were included in this study. Data was recorded for demographic details, diagnosis, indications, techniques of CVC insertion, and complications associated with CVC. The Central line-associated bloodstream infections (CLABSIs) were defined based on a positive CVC tip culture with a positive blood culture.
Results: 615 CVCs were inserted into 520 patients in children aged 1 month to 14 years. US-guided catheterization was performed only in 15.61% (96) cases, and the landmark method was used in 84.39% (519) of the CVC insertions. The femoral vein was the most accessed site (54.79%) followed by the internal jugular (36.59%), and subclavian vein (8.62%). The median CVC dwell time was 5 (3–8) days. The success rate of CVC insertion in the first attempt (US 53% vs. LM 28%; p<0.05) and overall success (US 89% vs. LM 76%; p<0.05) was significantly higher in the US group. Although higher complications were observed in the femoral vein, the difference was insignificant (p>0.05).
Conclusion: The study’s findings were conclusive that US guidance reduces complications significantly and makes the procedure more efficient. No significant correlation was observed between the site of insertion and complications.
Downloads
Metrics
References
Scholten HJ, ten Bloemendal E, Botter B, Korsten HHM, Bouwman RA. Barriers to ultrasound guidance for central venous access: a survey among Dutch intensivists and anesthesiologists. J Clin Monit Comput. 2019;33(6):1023-1031. DOI:10.1007/s10877-018-00246-z
Ares G, Hunter CJ. Central venous access in children: indications, devices, and risks. Curr Opin Pediatr. 2017 Jun;29(3):340-346. doi: 10.1097/MOP.0000000000000485.
Dassinger MS, Renaud EJ, Goldin A, et al. Use of real-time ultrasound during central venous catheter placement: Results of an APSA survey. J Pediatr Surg. 2015;50(7):1162-1167. DOI:10.1016/j.jpedsurg.2015.03.003
Guilbert AS, Xavier L, Ammouche C, Desprez P, Astruc D, Diemunsch P, Bientz J. Supraclavicular ultrasound-guided catheterization of the subclavian vein in pediatric and neonatal ICUs: a feasibility study. Pediatr Crit Care Med. 2013 May;14(4):351-5. doi: 10.1097/PCC.0b013e3182745489.
Pietroboni PF, Carvajal CM, Zuleta YI, et al. Landmark versus ultrasound-guided insertion of femoral venous catheters in the pediatric intensive care unit: An efficacy and safety comparison study. Med Intensiva. 2020;44(2):96-100. DOI:10.1016/j.medin.2019.07.014
Azizov S, Sahutoglu C, Bor C, Balcioglu T. Do not trust landmarks and your feelings while inserting pediatric central venous catheters. Ain-Shams J Anesthesiol. 2022;14(1). DOI:10.1186/s42077-022-00293-4
Aouad MT, Kanazi GE, Abdallah FW, et al. Femoral vein cannulation performed by residents: A comparison between ultrasound-guided and landmark technique in infants and children undergoing cardiac surgery. Anesth Analg. 2010;111(3):724-728. DOI:10.1213/ANE.0b013e3181e9c475
Jarraya A, Kammoun M, Chtourou A, Ammar S, Kolsi K. Complications and its risk factors of percutaneous subclavian vein catheters in pediatric patients: enhancing the outcomes of a university hospital in a low-income and middle-income country. World J Pediatr Surg. 2023;6(1):e000523. DOI:10.1136/wjps-2022-000523
Gray BW, Gonzalez R, Warrier KS, et al. Characterization of central venous catheter–associated deep venous thrombosis in infants. J Pediatr Surg. 2012;47(6):1159-1166. DOI:https://doi.org/10.1016/j.jpedsurg.2012.03.043
Camkiran Firat A, Zeyneloglu P, Ozkan M, Pirat A. A Randomized Controlled Comparison of the Internal Jugular Vein and the Subclavian Vein as Access Sites for Central Venous Catheterization in Pediatric Cardiac Surgery. Pediatr Crit Care Med. 2016 Sep;17(9):e413-9. doi: 10.1097/PCC.0000000000000878.
Pirat A, Camkiran A, Zeyneloglu P, Ozkan M, Akpek E, Arslan G. Comparison of internal jugular and subclavian access for central venous catheterization in pediatric cardiac surgery. Crit Care. 2012;16(1):P210. DOI:10.1186/cc10817
Celegen M, Celegen K. Determination of central venous catheter complications: Internal jugular vein versus femoral vein catheterization. Ann Med Res. 2023; 30(1): 98–101. DOI: 10.5455/annalsmedres.2022.08.268
Eisen LA, Narasimhan M, Berger JS, Mayo PH, Rosen MJ, Schneider RF. Mechanical Complications of Central Venous Catheters. J Intensive Care Med. 2006;21(1):40-46. DOI:10.1177/0885066605280884
de Souza TH, Brandão MB, Nadal JAH, Nogueira RJN. Ultrasound Guidance for Pediatric Central Venous Catheterization: A Meta-analysis. Pediatrics. 2018;142(5):e20181719. DOI:10.1542/peds.2018-1719
Froehlich CD, Rigby MR, Rosenberg ES, et al. Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit. Crit Care Med. 2009;37(3):1090-1096. DOI:10.1097/CCM.0b013e31819b570e
Bruzoni M, Slater BJ, Wall J, St Peter SD, Dutta S. A prospective randomized trial of ultrasound- vs landmark-guided central venous access in the pediatric population. J Am Coll Surg. 2013 May;216(5):939-43. Doi: 10.1016/j.jamcollsurg.2013.01.054.
Silvetti S, Aloisio T, Cazzaniga A, Ranucci M. Jugular vs femoral vein for central venous catheterization in pediatric cardiac surgery (PRECiSE): Study protocol for a randomized controlled trial. Trials. 2018;19(1). DOI:10.1186/s13063-018-2717-1
Eldabaa A, Elgebaly A, Elhafz A, Bassuni A. Comparison of ultrasound-guided vs. anatomical landmark-guided cannulation of the femoral vein at the optimum position in infant. Southern Afr J Anaesth Analg. 2012; 18(3): 162–166. DOI: 10.1080/22201173.2012.10872846
Oulego-Erroz I, González-Cortes R, García-Soler P, et al. Ultrasound-guided or landmark techniques for central venous catheter placement in critically ill children. Intensive Care Med. 2018;44(1):61-72. DOI:10.1007/s00134-017-4985-8
Sidoti A, Brogi E, Biancofiore G, et al. Ultrasound- versus landmark-guided subclavian vein catheterization: a prospective observational study from a tertiary referral hospital. Sci Rep. 2019;9(1). DOI:10.1038/s41598-019-48766-1
Lau CS, Chamberlain RS. Ultrasound-guided central venous catheter placement increases success rates in pediatric patients: a meta-analysis. Pediatr Res. 2016 Aug;80(2):178-84. doi: 10.1038/pr.2016.74.
Froehlich CD, Rigby MR, Rosenberg ES, Li R, Roerig PL, Easley KA, Stockwell JA. Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit. Crit Care Med. 2009 Mar;37(3):1090-6. DOI: 10.1097/CCM.0b013e31819b570e.
Keiler J, Seidel R, Wree A. The femoral vein diameter and its correlation with sex, age and body mass index – An anatomical parameter with clinical relevance. Phlebology. 2019;34(1):58-69. DOI:10.1177/0268355518772746
Akingbola OA, Nielsen J, Hopkins RL, Frieberg EM. Femoral vein size in newborns and infants: preliminary investigation. Crit Care. 2000;4(2):120-3. doi: 10.1186/cc666.
Karapinar B, Cura A. Complications of central venous catheterization in critically ill children. Pediatr Int. 2007 Oct;49(5):593-9. doi: 10.1111/j.1442-200X.2007.02407.x.
Venkataraman ST, Thompson AE, Orr RA. Femoral Vascular Catheterization in Critically Ill Infants and Children. Clin Pediatr (Phila). 1997;36(6):311-319. DOI:10.1177/000992289703600601
de Jonge RC, Polderman KH, Gemke RJ. Central venous catheter use in the pediatric patient: mechanical and infectious complications. Pediatr Crit Care Med. 2005 May;6(3):329-39. doi: 10.1097/01.PCC.0000161074.94315.0A.
Goldstein AM, Weber JM, Sheridan RL. Femoral venous access is safe in burned children: An analysis of 224 catheters. J Pediatr. 1997;130(3):442-446. DOI:10.1016/S0022-3476(97)70208-7
García-Teresa MÁ, Casado-Flores J, Delgado Domínguez MÁ, et al. Infectious complications of percutaneous central venous catheterization in pediatric patients: A Spanish multicenter study. Intensive Care Med. 2007;33(3):466-476. DOI:10.1007/s00134-006-0508-8
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
