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[Our experiences during cannulation of the subclavian vein in children (author's transl)]
Insights
Subclavian vein cannulation in children under 12 achieved an 85.9% success rate, with outcomes influenced by patient weight. Serious complications were rare and manageable.
Area of Science:
- Pediatric critical care medicine
- Vascular access procedures
Context:
- Central venous catheterization is crucial for pediatric patient management.
- Subclavian vein access is a common but technically demanding procedure in children.
- Limited data exists on subclavian vein cannulation success rates and complications in young children.
Purpose:
- To evaluate the success rate and safety of subclavian vein cannulation in pediatric patients.
- To identify factors influencing cannulation success, such as patient age and weight.
- To document the incidence and nature of complications associated with the procedure.
Summary:
- A 3-year study involving 260 children (under 12 years) performed 455 subclavian vein cannulations with an 85.9% success rate.
- Success rates were lower in younger children and correlated with lower body weight.
- Cannula tips were most commonly located in the upper caval vein (68.8%).
- The study involved 15 practitioners with varying experience levels.
- Cannulas functioned for an average of 5 days, with a maximum of 19 days.
- The most serious complications included pneumothorax and suspected thrombosis, none requiring significant therapeutic intervention.
Impact:
- Provides valuable data on the feasibility and safety of subclavian vein cannulation in a pediatric population.
- Highlights the importance of patient weight as a predictor of success.
- Informs clinical practice regarding central venous access in neonates and infants.
- Contributes to the evidence base for pediatric interventional procedures.
Abstract:
With 260 children under 12 years of age we tried to cannulate the subclavian vein during 3 years 455 times, and were successful 391 times (85.9%). 43.8% of the patients were younger than 1 year. The success rate correlated to the childrens' bodyweight and was less with lower weight of the patients. - In 68.8% of the cases we found the tip of the cannula in the upper caval vein, 19.9% were in the internal jugular vein, and 6.1% were in the opposite subclavian vein. - In this study participated 7 members of the staff and 8 specializing doctors; catheterizations per participant, mean = 30,2, SD 21,49, minimum 6, maximum 65. - Cannulas functioned for 5 +/- 2, max. 19 days. - The most serious complications were 2 pneumo- and one pneumo-hydrothorax, 2 times suspicion of thrombosis and 1 hemorrhage due to a not known hemophilia. None of the complications caused therapeutical problems.