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A Retrospective Observational Cohort Study of Ultrasound-guided Subclavian Central Venous Cannulation in Children
Lior Shtayer1, Jennifer M Lynch2, Benjamin Kozyak3
1Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Objectives:
There is currently limited data regarding the use of ultrasound (US)-guided subclavian (SC) central venous catheters (CVCs) in pediatric patients undergoing cardiac surgery. The primary aim of this study was to determine the incidence of complications associated with US-guided SC-CVC placement. The secondary aims were to identify risk factors for US-guided SC-CVC complications.
Design:
A retrospective, observational cohort study between 2021 and 2024.
Setting:
A single-center, quaternary pediatric cardiac program.
Participants:
A total of 93 children who underwent US-guided SC-CVC placement before cardiac surgery.
Interventions:
None.
Measurement And Main Results:
A total of 857 cases were screened for eligibility; 103 SC-CVCs were placed during cardiac surgery, and 93 patients met all inclusion criteria and were included in the final study cohort. No patients had documented hematoma, arterial puncture, pneumothorax, or central line-associated bloodstream infection. One patient (1.1%) had an SC-line-associated nonocclusive thrombus. Catheter malposition was noted in 8.6% (8/93) of patients, more commonly involving the catheter tip positioned in the ipsilateral internal jugular vein (5/93) or contralateral brachiocephalic vein (3/93). Multivariate logistic regression identified higher patient weight as a risk factor for catheter malposition (odds ratio: 1.09, 95% confidence interval: 1.02-1.17) while increased catheter length was a protective factor against catheter malposition (odds ratio: 0.47, 95% confidence interval: 0.27-0.82).
Conclusions:
In a large cohort of pediatric patients with US-guided SC-CVCs undergoing cardiac surgery, the most common complication was catheter malposition. This study suggests that US-guided SC-CVC cannulation is a feasible option for perioperative central venous access for pediatric cardiac surgery.
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