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Open versus Transcutaneous (Ultrasound-Guided and Based on Anatomic Landmarks) Tunneled Venous Access to the Right
Niki Kouna1, George Noutsos2, Christina Koufopoulou3
12nd Department of Anesthesiology, Attiko University Hospital, 12462 Athens, Greece.
Insights
Comparing central venous catheter insertion techniques in children, ultrasound guidance showed fewer complications like thrombosis and infection than open surgery or landmark-based methods. This technique is safe and effective for pediatric patients.
Area of Science:
- Pediatric Medicine
- Vascular Surgery
- Medical Devices
Background:
- Central venous catheters (CVCs) are crucial in pediatric care.
- Insertion techniques vary, including open surgical, ultrasound-guided, and landmark-based methods.
- Complication rates and procedural efficiency differ among these techniques.
Purpose of the Study:
- To compare immediate and long-term complications of CVC insertion techniques in pediatric patients.
- To evaluate the safety and efficacy of open surgical, ultrasound-guided, and landmark-based techniques.
- To assess procedural time and catheter dwell duration across different methods.
Main Methods:
- Prospective randomized trial in a tertiary pediatric-oncological hospital.
- Inclusion of pediatric patients under 16 years of age.
- Comparison of complication rates (thrombosis, infection), procedure time, and line use duration across three insertion techniques.
Main Results:
- Ultrasound-guided technique (34.9%) and open surgical technique (39.5%) were most common, followed by landmark-based (25.4%).
- Higher rates of thrombosis were observed with landmark-based and open surgical techniques.
- Increased incidence of infection was noted with the landmark-based transcutaneous technique.
Conclusions:
- Ultrasound-guided percutaneous CVC insertion is safe and effective in pediatric populations.
- This technique may reduce operating times with increasing operator expertise.
- Ultrasound guidance preserves venous lumen diameter without increasing complication rates.
Background:
The purpose of this study was to compare the immediate and long-term complications that are associated with the utilized techniques for the insertion of indwelling central venous catheters, that is the open surgical technique, the ultrasound-guided technique, and the transcutaneous technique based on external anatomical landmarks in the right internal jugular vein, to a pediatric population.
Methods:
This was a prospective randomized trial based on a pediatric patient population under 16 years of age of a tertiary pediatric-oncological hospital. The procedure was performed by a medical team with varying experience regarding the percutaneous and open insertion methods. We studied the outcome of our procedure, based on the immediate and delayed complication rate, as well as the needed time in order to complete the procedure and mean duration of line use.
Results:
The patients that were inserted in our protocol were divided into three subgroups based on the selected technique for the insertion of the central venous catheter. A total number of 88 insertions (25.4%) (out of 346) were based on the technique that was using external anatomical landmarks, 121 insertions were based on the ultrasound-guided transcutaneous technique (34.9%), whereas in 137 cases (39.5%) the open surgical technique was preferred. All cases that were related to catheter re-insertion were excluded from our study. We performed a statistical analysis regarding the catheter dwell time between the three subgroups of patients and no significant difference was recorded. Moreover, the development of thrombosis was investigated, and we noted that a higher percentage of this complication was related to the transcutaneous external landmark and open surgical technique. Also, the incidence of infection was taken into consideration, which manifested an increased incidence when the transcutaneous technique based on external landmarks was used.
Conclusions:
Ultrasound-guided percutaneous insertion was considered to be a safe and effective technique for the insertion of central venous catheters. Our study also demonstrated a decrease in operating times when performed by operators with increasing expertise, increased preservation of the diameter of the venous lumen, and no increase in complication rates when the ultrasound-guided technique was selected.
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