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Subclavian vein catheterization in critically ill children: analysis of 322 cannulations
J Casado-Flores1, A Valdivielso-Serna, L Pérez-Jurado
1Pediatric Intensive Care Unit, Niño Jesús Hospital, Autónoma University of Madrid, Spain.
Insights
Percutaneous subclavian vein catheterization in children is safe and effective. This study found few serious complications, with most incidents during insertion, particularly on the right side.
Area of Science:
- Pediatric Surgery
- Vascular Access
- Infectious Disease
Background:
- Subclavian vein catheterization is a common procedure in pediatric care for vascular access.
- Understanding complication rates and risk factors is crucial for patient safety.
- The infraclavicular approach is frequently used for subclavian catheter placement in children.
Purpose of the Study:
- To prospectively investigate complications associated with percutaneous subclavian vein catheters in children.
- To identify factors influencing complication rates, including insertion side and duration of use.
- To assess the incidence of catheter-related infections and associated microorganisms.
Main Methods:
- Prospective investigation of 322 subclavian vein catheters placed in 272 pediatric patients.
- Data collection on incidents during insertion, catheter maintenance, and infection rates.
- Statistical analysis to determine associations between complications, insertion side, age, and duration.
Main Results:
- 13 incidents occurred during catheter introduction, more frequent on the right side (p < 0.01).
- Nine urgent treatments were required (2.8%), including pneumothorax, hydrothorax, and hemothorax.
- Catheter-related sepsis occurred in 6 cases (3.2%), with Staphylococcus epidermidis being the most common organism (58%).
- Longer catheterization (>5 days) and Staphylococcus epidermidis isolation were associated with increased risk (p < 0.05).
Conclusions:
- Percutaneous subclavian vein catheterization via the infraclavicular approach is a safe and useful procedure in pediatric patients.
- Experienced practitioners can minimize serious complications, although insertion-related events require attention.
- Proactive monitoring and management are essential to reduce risks of infection and thrombosis, especially for prolonged use.
Abstract:
Complications in 322 percutaneous subclavian vein catheters placed in 272 children by the infraclavicular approach were investigated prospectively. Ages ranged from 4 days to 15 years. Incidents during catheter introduction occurred in 13 cases, and were more common when insertion was on the right side (p less than 0.01). Nine (2.8%) required urgent treatment: (6 pneumothorax, 1 hydrothorax, and 2 hemothorax). Anomalous lodging of the catheter tip was more common when insertion was on the right side (p less than 0.05). Complications during catheter maintenance were 3 venous thromboses, 3 catheter obstructions, and 7 migrations out of position. There was no significant difference in complications related to age. Catheter cultures were positive in 33 (17%) of 190 catheters cultured (27 through colonization and 6 through catheter-related sepsis). Staph. epidermidis was the organism most frequently isolated (19 cases; 58%). Catheterization time of more than 5 days and catheter-related sepsis were statistically associated (p less than 0.05). Staph. epidermidis isolation and duration of cannula use were statistically related (p less than 0.01). No catheter-related deaths occurred. We conclude that subclavian vein catheterization is a simple and useful procedure that entails relatively few serious complications when performed by experienced pediatricians.