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Percutaneous insertion of subclavian venous catheters in infants and children
E V Bonventre1, K P Lally, W J Chwals
1Department of Surgery, Wilford Hall United States Air Force Medical Center, Lackland Air Force Base, Texas 78236.
Insights
Subclavian venous catheterization in children is safe and effective, with a 71% success rate. Using fluoroscopy improves success and reduces complications, especially on the left side.
Area of Science:
- Pediatric Surgery
- Vascular Access
Background:
- Subclavian venous catheterization is a common procedure in pediatric patients.
- Assessing the safety and efficacy of this technique is crucial for patient care.
Purpose of the Study:
- To prospectively evaluate subclavian venous catheterization attempts in pediatric patients.
- To identify complication rates and success rates associated with the procedure.
Main Methods:
- A prospective study of 107 pediatric patients undergoing subclavian venous catheterization.
- Data collection on success rates, complication types (arterial puncture, pneumothorax, abnormal position), and use of fluoroscopy.
Main Results:
- An overall success rate of 71% was achieved in 107 attempts.
- Major complications included arterial puncture (8.0%), pneumothorax (2.4%), and abnormal catheter position (12.8%).
- Fluoroscopy use was associated with an 86% success rate and lower malposition rates, particularly on the left side.
Conclusions:
- Percutaneous subclavian venous catheterization is feasible in children with low morbidity.
- Left-sided catheterization offers similar success rates with a reduced risk of malposition compared to the right side.
- Fluoroscopy is a valuable tool for ensuring correct catheter placement.
Abstract:
All attempts at subclavian venous catheterization by the Pediatric Surgery Service done during a one and one-half year period at the Children's Hospital of Los Angeles were prospectively studied. Catheterization was attempted in 107 patients with a mean age of 9.8 years. Cannulation of the vein was successful 89 times (71 per cent) with the major complications being arterial puncture (8.0 per cent), pneumothorax (2.4 per cent) and abnormal position (12.8 per cent). Fluoroscopy was a valuable adjunct when used, resulting in an 86 per cent success rate. The serious complication rate was similar between left and right-sided attempts, but more catheters were abnormally positioned during right-sided attempts (15.7 versus 5.2 per cent). Percutaneous insertion of subclavian venous catheters can be accomplished in infants and children with low morbidity. Cannulation of the left subclavian vein can be accomplished with a similar success rate and a lower malposition rate than the right side. Fluoroscopy is a useful tool to assist in the correct placement of the catheter.