Subclavian Broviac catheters in children--technical considerations in 146 consecutive placements

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.