A Randomized Trial of Ultrasound- versus. Fluoroscopy-Guided Subclavian Vein Catheterization in Children with...

Area of Science:

• Pediatric Hematology
• Vascular Access Procedures
• Medical Imaging Techniques

Background:

• Subclavian vein catheterization is crucial for pediatric patients with hematologic diseases.
• Accurate and safe venous access is essential for treatment delivery and patient outcomes.
• Current guidance methods include ultrasound and fluoroscopy, each with potential benefits and drawbacks.

Purpose of the Study:

• To compare the efficacy and safety of ultrasound-guided versus fluoroscopy-guided subclavian vein catheterization in pediatric patients with hematologic diseases.
• To evaluate key outcomes such as cannulation success, procedural time, and complication rates.

Main Methods:

• A randomized prospective study involving 170 pediatric patients with hematologic diseases.
• Patients were randomly assigned to either ultrasound-guided or fluoroscopy-guided subclavian vein catheterization.
• Primary outcome: number of attempts for venous cannulation; Secondary outcomes: success rate, fluoroscopy time, operation time, and complications.

Main Results:

• Ultrasound guidance resulted in a significantly higher success rate within 3 attempts (92.0%) compared to fluoroscopy (78.3%).
• No significant differences were observed in average operation time or overall surgical complications between the groups.
• While the fluoroscopy group had no catheter-related thrombosis (CRT), the ultrasound group had 4 CRTs during follow-up.

Conclusions:

• Ultrasound-guided venous puncture offers superior accuracy for subclavian vein catheterization in this pediatric cohort.
• Fluoroscopy provides greater precision for catheter tip placement.
• A combined ultrasound- and fluoroscopy-guided approach is suggested to enhance efficiency in subclavian vein catheterization for children with hematologic disease.