Related Experiment Videos
Percutaneous catheterization of the axillary vein in infants and children
R I Metz1, S E Lucking, F C Chaten
1Department of Pediatrics, Children's Medical Center, Medical College of Virginia, Richmond 23298.
Insights
The axillary vein offers a viable alternative for central venous catheterization in critically ill children. This study shows comparable success and complication rates to other methods.
Area of Science:
- Pediatric Critical Care Medicine
- Vascular Access Procedures
- Interventional Cardiology
Background:
- Central venous catheterization is essential for critically ill infants and children.
- Alternative access sites are needed to improve safety and efficacy.
- The axillary vein has been explored as a potential site.
Purpose of the Study:
- To evaluate the axillary vein as an alternative access site for central venous catheterization.
- To determine the success and complication rates of axillary vein catheterization.
- To compare these rates with established methods like jugular catheterization.
Main Methods:
- Prospective evaluation of central venous catheterization via the axillary vein in critically ill pediatric patients.
- Patients positioned in Trendelenburg with arm abduction (100-130 degrees).
- Vein entry parallel and inferior to the axillary artery.
Main Results:
- Catheterization success rate was 79% (41/52).
- Median catheter duration was 8 days, with 338 total patient catheter-days.
- Insertion complications (3.8%) and in-dwelling complications (9.8%) were low and comparable to jugular access.
Conclusions:
- The axillary vein approach is an acceptable and safe route for central venous catheterization in pediatric critical care.
- Success and complication rates are comparable to the internal jugular vein.
- This method provides a valuable alternative for vascular access in this population.
Abstract:
The axillary vein was evaluated as an alternative access site for central venous catheterization in critically ill infants and children. Children were placed in the Trendelenberg position (when possible) with arm abducted 100 to 130 degrees. The vein was entered parallel and inferior to the artery. Success rate for catheterization was 79% (41/52). Catheter diameter range was 3 to 8.5 F and catheter length range was 5 to 30.5 cm. Median patient weight was 7.0 kg (3.0 to 59 kg). Median age was 0.91 years (14 days to 9 years). All central lines ended in the subclavian, innominate, or superior vena cava. Median catheter duration was 8 days (2 to 22 days). A total of 338 patient catheter-days were studied. Central venous pressure was successfully monitored in five of five attempts. Complications with insertion (3.8% of attempts) included one pneumothorax and one hematoma. Complications during catheter duration (9.8% of catheters, 1.1% per catheter-day) included one instance each of venous stasis, venous thrombosis, catheter sepsis, and parenteral nutrition infiltration. No complication contributed to a patient mortality. Success and complication rates were comparable with those in jugular catheterization studies in children. The axillary approach is an acceptable route for central venous catheterization in critically ill infants and children.