Central venous catheters in pediatric patients--subclavian venous approach as the first choice

Area of Science:

• Pediatric critical care medicine
• Vascular access procedures
• Patient safety in intensive care

Background:

• Establishing reliable intravenous (IV) access is crucial for managing critically ill pediatric patients.
• Central venous catheters (CVCs) are essential for fluid resuscitation, medication delivery, and monitoring in pediatric intensive care units (PICUs).
• Evaluating the application frequency and associated complications of CVCs in PICU settings is vital for optimizing patient care.

Purpose of the Study:

• To determine the frequency of central venous catheter insertion in a pediatric intensive care unit.
• To identify and analyze the complications associated with central venous catheter use in pediatric patients.
• To assess the safety and efficacy of different central venous catheter insertion sites.

Main Methods:

• A retrospective study of pediatric patients undergoing central venous catheter insertion between March 1997 and May 1999.
• Data collected included patient demographics, indication for catheterization, insertion site, duration of catheter dwell, and observed complications.
• Analysis focused on the frequency of application and types of complications, including arterial injury, pneumothorax, and catheter-related infections.

Main Results:

• A total of 156 central venous catheters were inserted in 146 pediatric patients.
• The subclavian vein was the preferred insertion site, utilized in 94.9% of cases.
• Complications included arterial injury (12.8%), pneumothorax (1.3%), and catheter-related infections (1.9%), with a 0% mortality rate.

Conclusions:

• Subclavian central venous catheterization is a safe and effective procedure in pediatric patients, characterized by a high success rate and low complication profile.
• Arterial injury emerged as the most frequent complication, highlighting the need for skilled insertion techniques.
• Given its safety and efficacy, subclavian central venous catheter insertion is recommended as a primary approach for critically ill pediatric patients requiring central venous access.