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Published on: July 13, 2019
Central Venous Catheter Cannulation in Pediatric Anesthesia and Intensive Care: A Prospective Observational Trial
Václav Vafek1,2, Tamara Skříšovská1,2, Martina Kosinová1,2
1Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavská 20, 62500 Brno, Czech Republic.
Insights
Ultrasound-guided central venous catheter (CVC) insertion showed a trend towards higher success rates in pediatric patients compared to landmark-based methods. Further research is needed to confirm these findings and optimize CVC placement.
Area of Science:
- Pediatric Critical Care Medicine
- Medical Imaging and Ultrasound Applications
- Vascular Access Procedures
Background:
- Ultrasound-guided central venous catheter (CVC) insertion is the recommended practice for pediatric patients.
- Clinical adherence to ultrasound guidance for CVC placement may vary.
- Anatomic-based (landmark) CVC insertion remains an alternative method.
Purpose of the Study:
- To compare the overall and first-attempt success rates of ultrasound-guided versus landmark-based CVC insertion in pediatric patients.
- To evaluate the incidence of complications associated with each CVC insertion method.
- To assess and compare the procedural time for both techniques.
Main Methods:
- A prospective study involving 107 pediatric patients undergoing CVC insertion.
- Physicians could choose between real-time ultrasound navigation and landmark-based methods.
- Data collected included success rates, complication incidence, and procedural duration.
Main Results:
- Overall success rates were 100% for ultrasound guidance and 96.4% for landmark methods (p=0.496).
- First-attempt success rates were 57.7% for ultrasound and 45.5% for landmark methods (p=0.460).
- Ultrasound guidance demonstrated higher, though not statistically significant, success rates for both overall and first attempts.
Conclusions:
- Real-time ultrasound navigation for pediatric CVC insertion shows a trend towards improved success rates compared to the landmark method.
- While not statistically significant in this study, the observed higher success rates support the continued use and recommendation of ultrasound guidance.
- Further investigation with larger sample sizes may be warranted to definitively establish the superiority of ultrasound guidance for pediatric CVC insertion.
Abstract:
Currently, ultrasound-guided central venous catheter (CVC) insertion is recommended in pediatric patients. However, the clinical practice may vary. The primary aim of this study was the overall success rate and the first attempt success rate in ultrasound-guided CVC insertion versus anatomic-based CVC insertion in pediatric patients. The secondary aim was the incidence of associated complications and the procedural time. The physician could freely choose the cannulation method and venous approach. Data were collected for 10 months. Overall, 179 patients were assessed for eligibility and 107 patients were included. In almost half of the patients (48.6%), the percutaneous puncture was performed by real-time ultrasound navigation. In 51.4% of the patients, the puncture was performed by the landmark method. The overall success rate was 100% (n = 52) in the real-time ultrasound navigation group, 96.4% (n = 53) in the landmark insertion group, (p = 0.496). The first percutaneous puncture success rate was 57.7% (n = 30) in the real-time ultrasound navigation group and 45.5% (n = 25) in the landmark insertion group, (p = 0.460). The data show a higher overall success rate and the first success rate in the US-guided CVC insertion group, but the difference was not statistically significant.
