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Published on: December 23, 2014
Ultrasound-guided or landmark techniques for central venous catheter placement in critically ill children
Ignacio Oulego-Erroz1, Rafael González-Cortes2, Patricia García-Soler3
1Paediatric Intensive Care Unit, Complejo Asistencial Universitario de León, Altos de Nava s/n, 24008, León, Spain. ignacio.oulego@gmail.com.
Insights
Ultrasound guidance significantly improves central venous catheter (CVC) placement success in critically ill children. This method reduces puncture attempts and complications compared to the traditional landmark technique.
Area of Science:
- Pediatric Critical Care Medicine
- Medical Ultrasound Applications
- Vascular Access Procedures
Background:
- Central venous catheter (CVC) placement is crucial for critically ill children.
- Traditional landmark techniques for CVC insertion can be challenging and associated with complications.
- Optimizing CVC placement techniques is essential for improving patient outcomes in pediatric intensive care units.
Purpose of the Study:
- To evaluate the efficacy of ultrasound guidance versus the landmark technique for central venous catheter placement in critically ill children.
- To compare first-attempt success rates, number of attempts, and mechanical complications between the two techniques.
Main Methods:
- A prospective, multicenter observational study involving 26 pediatric intensive care units.
- Inclusion of children aged 0-18 years undergoing temporary CVC insertion via ultrasound or landmark guidance.
- Propensity score matching (1:1) was used to control for confounding factors, followed by generalized estimating equations and mixed-effects models for analysis.
Main Results:
- Ultrasound guidance was associated with a higher first-attempt success rate (46.6% vs. 30%) compared to the landmark technique.
- Fewer puncture attempts (mean difference -0.51) and reduced overall mechanical complications (12% vs. 22.5%) were observed with ultrasound guidance.
- The number of puncture attempts was identified as a key factor contributing to overall complications.
Conclusions:
- Ultrasound guidance significantly enhances the first-attempt success rate for central venous catheter placement in critically ill children.
- The use of ultrasound reduces the number of puncture attempts and the incidence of mechanical complications.
- Ultrasound guidance represents a superior technique for CVC insertion in this vulnerable patient population.
Purpose:
To assess whether ultrasound guidance improves central venous catheter placement outcomes compared to the landmark technique in critically ill children.
Methods:
A prospective multicentre observational study was carried out in 26 paediatric intensive care units over 6 months. Children 0-18 years old who received a temporary central venous catheter, inserted using either ultrasound or landmark techniques, were eligible. The primary outcome was the first-attempt success rate. Secondary outcomes included overall placement success, number of puncture attempts, number of procedures requiring multiple punctures (> 3 punctures), number of procedures requiring punctures at more than one vein site and immediate mechanical complications. To account for potential confounding factors, we used propensity scores. Our primary analysis was based on 1:1 propensity score matching. The association between cannulation technique and outcomes in the matched cohort was estimated using generalized estimating equations and mixed-effects models to account for patient-level and hospital-level confounders.
Results:
Five hundred central venous catheter-placement procedures involving 354 patients were included. Ultrasound was used for 323 procedures, and the landmark technique was used for 177. Two hundred and sixty-six procedures were matched (133 in the ultrasound group and 133 in the landmark group). Ultrasound was associated with an increase in the first-attempt success rate [46.6 vs. 30%, odds ratio 2.09 (1.26-3.46); p < 0.001], a reduced number of puncture attempts [2 (1-3) vs. 2 (1-4), B coefficient - 0.51 (95% confidence interval - 1.01 to - 0.03), p = 0.035], and fewer overall mechanical complications [12 vs. 22.5%, odds ratio 0.47 (95% confidence interval 0.24-0.91), p = 0.025] in the matched cohort. The number of puncture attempts was the main factor associated with overall complications.
Conclusions:
Compared with the landmark technique, ultrasound guidance was associated with an increased first-attempt success rate, a reduced number of puncture attempts, and fewer complications during central venous catheter placement in critically ill children.
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