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A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
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A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit

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Practice Patterns of Central Venous Catheter Placement and Confirmation in Pediatric Critical Care

Ahmed Veten1, Joshua Davis2, Robert Kavanagh3

  • 1Department of Pediatric Critical Care, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States.

Journal of Pediatric Intensive Care
|August 5, 2022
PubMed

Insights

Practices for placing central venous catheters (CVCs) in critically ill children vary widely among pediatric critical care providers. Most use internal jugular or femoral sites, with less use of subclavian catheters and ultrasound guidance for confirmation.

Area of Science:

  • Pediatric Critical Care Medicine
  • Vascular Access Procedures
  • Medical Device Placement

Background:

  • Optimal practices for central venous catheter (CVC) placement in critically ill children remain unclear.
  • Significant variability exists in current clinical practices among pediatric critical care medicine (PCCM) providers.

Purpose of the Study:

  • To describe current clinical practices of PCCM providers regarding CVC site selection, confirmation methods, and complication assessment.
  • To identify potential gaps in training and practice for CVC insertion in pediatric critical care.

Main Methods:

  • An electronic survey was distributed to 214 PCCM providers (attending physicians, fellow physicians, advanced practice providers).
  • The survey assessed preferred CVC sites, confirmation modalities, and use of ultrasound (US) guidance.
  • Respondents reported on training in US or echocardiography for CVC placement.

Main Results:

  • Internal jugular (99%) and femoral (95%) sites are most commonly used for CVC placement; subclavian (40%) and peripherally inserted central catheters (PICCs) (19%) are less common.
  • The internal jugular site is most preferred (60%), citing decreased infection risk, while the subclavian site is least preferred due to complication concerns.
  • Dynamic US guidance is frequently used for IJ (90%), PICC (86%), and femoral (78%) CVCs, but less so for subclavian (12%). Plain radiography (X-ray) is the primary method for confirming tip position (85%) and evaluating pneumothorax.

Conclusions:

  • Wide variability exists in CVC placement practices among PCCM providers, highlighting a need for standardized optimal practices.
  • Potential training gaps were identified regarding subclavian catheter placement and the utilization of ultrasound for confirmation and complication assessment.
  • Further research and standardized training are recommended to improve the safety and efficacy of CVC placement in critically ill children.

Keywords:
central venous cathetereducationpediatric critical carepneumothoraxultrasoundvascular access

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