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Subclavian Broviac catheters in children--technical considerations in 146 consecutive placements
Insights
Subclavian Broviac catheters are safe for pediatric central venous access, with low complication rates. Cut-down insertion is recommended for very small infants if initial attempts fail.
Area of Science:
- Pediatric Surgery
- Vascular Access
- Critical Care Medicine
Background:
- Central venous catheters are essential for long-term fluid, medication, and nutritional support in children.
- Subclavian Broviac catheters are a common type of indwelling central venous access device used in pediatric patients.
- Assessing the safety and efficacy of subclavian Broviac catheter placement in a pediatric population is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate the insertion-related problems and complications associated with subclavian Broviac catheter placement in pediatric patients.
- To determine the overall morbidity and safety of this procedure in a diverse pediatric age and weight group.
- To provide recommendations for optimizing the procedure, particularly in high-risk infants.
Main Methods:
- A retrospective review of 146 subclavian Broviac catheter placements in 129 children over 42 months.
- Data collection included patient demographics, indications for catheterization, insertion techniques, procedural complications, and post-procedural outcomes.
- Analysis focused on insertion-related issues, complications, and patient factors influencing outcomes.
Main Results:
- 152 attempts were made in 129 children, with indications including parenteral nutrition, chemotherapy, and long-term medication administration.
- Insertion-related problems occurred in 24.3% of cases, with the most common being multiple punctures (17.7%) and initially misdirected catheters (8.9%).
- Overall complications were low, with no catheter-related mortality. However, severe complications occurred in very small infants, suggesting a need for modified approaches.
Conclusions:
- Subclavian Broviac catheter placement is associated with low morbidity in the pediatric population.
- For very small infants, a cut-down insertion technique is recommended if initial needle cannulation is unsuccessful to minimize risks.
- Careful patient selection and technique optimization can ensure safe and effective central venous access in children.
Abstract:
During a 42-month span, 146 subclavian Broviac type catheters were placed in 129 children. In an additional 6 patients, a venotomy was necessary for successful cannulation, bringing the total number of attempts to 152. Indications were: parenteral nutrition (78), chemotherapy/bone marrow transplant (54), longterm antibiotic or other medication administration (14). Fifty-two were under 1 year of age. Forty-one weighed less than 5 kg and 7 were under 1 kg. Thirty-five had previous central lines (subclavian Broviacs--15). Additional procedures were common (31). Eight had thrombocytopenia. Insertion related problems were inability to cannulate vein--6 (3.9%). All had successful catheter placement by cut down. Over five punctures--27 (17.7%). Initially misdirected catheters--13 (8.9%) and, Arterial puncture--four (2.6%). Complications were pneumothorax--two. Tube thoracostomy required in one (650 g). Subclavian vein thrombosis after unsuccessful cannulation--one (1500 g). Questionable phrenic nerve injury--one (900 g). Transient venous occlusion of left arm--one (650 g). Accidental catheter damage--two; and air embolization without consequences, perioperative catheter clotting, and hematoma of tract occurred once each. There was no catheter-related mortality. Because the only complications producing untoward sequelae were in very small infants, our present recommendation is that if successful cannulation of the subclavian is not possible with the first few passages of the needle, a cut-down insertion is preferred in this group. Our experience indicates that subclavian indwelling central catheter placement in the pediatric population can be accomplished with a low morbidity.