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Complications of central venous catheterization in critically ill children
Bulent Karapinar1, Alphan Cura
1Pediatric Intensive Care Unit, Ege University Faculty of Medicine, Izmir, Turkey. bkarapinar@hotmail.com
Insights
Central venous catheterization in critically ill children is safe, with a 1.3% serious complication rate. Femoral or internal jugular veins are preferred over subclavian for better success and fewer insertion complications.
Area of Science:
- Pediatric intensive care
- Vascular access procedures
- Critical care medicine
Background:
- Central venous catheters are vital for critically ill children.
- Evaluating central venous access sites is crucial for patient safety.
- Understanding complication risks associated with different venous access sites is essential.
Purpose of the Study:
- To assess the success rate of central venous catheterization in critically ill children.
- To identify mechanical and thrombotic complications.
- To determine risk factors for complications at various central venous access sites.
Main Methods:
- Prospective study conducted from February 2000 to March 2005.
- Included 369 central venous catheterizations in a pediatric intensive care unit.
- Data collected on success rates, complications, and risk factors.
Main Results:
- Overall success rate was 92.4%. Femoral (45%), subclavian (32.2%), and internal jugular (22.8%) veins were most used.
- Insertion complications (arterial puncture, malposition, hematoma, pneumothorax) were more frequent with subclavian vein access.
- Maintenance complications (obstruction, thrombosis, removal) increased with catheter duration and were higher with femoral access.
Conclusions:
- Central venous catheterization in critically ill children is generally safe, with a 1.3% serious complication rate and no mortality.
- Femoral or internal jugular veins appear safer than the subclavian vein due to higher success and fewer insertion-related issues.
- Minimizing catheter dwell time and attempts can reduce complication risks.
Background:
Placement of central venous catheter is essential in the management of critically ill children. The purpose of the present paper was to evaluate the success rate, mechanical and thrombotic complications and risk factors associated with these complications from different central venous access sites in critically ill children.
Methods:
A prospective study was undertaken from February 2000 to March 2005 of 369 central venous catheterizations in children in a pediatric intensive care unit.
Results:
The veins most frequently used were femoral vein (45%), subclavian vein (32.2%), and internal jugular vein (22.8%). Mean +/- SD duration of catheterization was 9.5 +/- 6.5 days. The procedure was performed under emergency conditions in 18% of patients with an overall success rate of 92.4%. The success rate was significantly lower in younger patients with subclavian catheterization. Insertion-related complications were noted, including 33 arterial punctures (8.9%), 27 cases of malposition (7.3%), 19 hematomas (5.2%), 12 cases of minor bleeding (3.3%), and three cases of pneumothorax (0.8%), and they were more common in the subclavian vein than in the internal jugular and femoral vein. Multiple attempts and failed attempts significantly correlated with higher incidence of complications. Maintenance-related complications included obstruction (n = 26; 7%), accidental removal (n = 14; 3.8%), central venous thrombosis (n = 8; 2.2%), subcutaneous extravasation (n = 14; 3.8%), dislodgment (n = 1; 0.25%), and extravascular infusion (n = 1; 0.25%). The frequency of catheter maintenance-related complications was significantly higher in femoral catheterizations and increased significantly with an increase in the duration of catheterization. A total of five serious complications were seen (pneumothorax in three, dislodgment in one and extravascular infusion in one) in the present series.
Conclusions:
Central venous catheterization in critically ill children is a relatively safe procedure, with a 1.3% rate of serious complications and no mortality. It seems safer to choose initially the femoral or internal jugular vein instead of the subclavian vein because of high success rate without serious insertion-related complications.
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